Quality standard

Quality statement 6: Cardiac rehabilitation

Quality statement 6: Cardiac rehabilitation

Quality statement

Adults with chronic heart failure receive a personalised programme of cardiac rehabilitation. [2011, updated 2023]

Rationale

A personalised programme of cardiac rehabilitation delivered by an appropriate method, preceded by an assessment to ensure that it is suitable, can help to extend and improve the quality of a person's life. Cardiac rehabilitation uses monitored exercise, psychological support and education about lifestyle changes to reduce the risks of further heart problems. It can also reduce uncertainty and anxiety about living with chronic heart failure. Through better management of their condition, the person may have greater opportunities to return to normal activities.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of adults with chronic heart failure who have a record of referral to a personalised programme of cardiac rehabilitation.

Numerator – the number in the denominator who have a record of referral to a personalised programme of cardiac rehabilitation.

Denominator – the number of adults with chronic heart failure.

Data source: The National Heart Failure Audit contains data on patients discharged alive after an admission with acute heart failure referred as an inpatient to cardiac rehabilitation.

b) Proportion of adults with chronic heart failure who receive a personalised programme of cardiac rehabilitation.

Numerator – the number in the denominator who receive a personalised programme of cardiac rehabilitation.

Denominator – the number of adults with chronic heart failure.

Data source: National data on the uptake of cardiac rehabilitation is available from the NHS National Audit of Cardiac Rehabilitation.

Outcome

a) Rates of people with chronic heart failure completing programmes of cardiac rehabilitation.

Data source: National data on the proportion of people with chronic heart failure completing cardiac rehabilitation are available from the NHS National Audit of Cardiac Rehabilitation.

b) Patient outcomes following programmes of cardiac rehabilitation.

Data source: National data on patient outcomes following cardiac rehabilitation such as physical activity, BMI, anxiety and depression are available from the NHS National Audit of Cardiac Rehabilitation.

What the quality statement means for different audiences

Service providers (GP practices, community nursing teams and hospitals) ensure that referral pathways to personalised programmes of cardiac rehabilitation that include a monitored exercise, a psychological component and an educational component are available for adults with chronic heart failure.

Healthcare professionals (such as GPs, cardiac rehabilitation nurses and specialists in cardiac care) ensure that they refer adults diagnosed with chronic heart failure to a personalised programme of cardiac rehabilitation, once they are well enough to take part.

Commissioners (integrated care systems and local authorities) ensure that they commission services in which personalised cardiac rehabilitation programmes that include a monitored exercise, a psychological component and an educational component are available for adults with chronic heart failure.

Adults with chronic heart failure are offered a personalised programme of cardiac rehabilitation if it is suitable for them, once they are well enough to take part. This programme includes help and support with taking exercise, help with understanding their condition, support with their thoughts and feelings around the condition, and help with how to look after themselves.

Definitions of terms used in this quality statement

Personalised programme of cardiac rehabilitation

This is an exercise-based programme of rehabilitation designed for people with chronic heart failure that includes a psychological and educational component. It should be accompanied by information about support available from healthcare professionals. The information should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible. It should be suited to the person, their condition, and their needs. [Adapted from NICE's guideline on chronic heart failure in adults, recommendation 1.9.1]

Equality and diversity considerations

A programme of cardiac rehabilitation should be accessible for all adults with chronic heart failure, including those who may be housebound or in a nursing home. A range of formats (for example, online, in person) and settings (at home, in the community or in the hospital) should be provided so that everyone has their needs met.

When conducting cardiac rehabilitation in the community or in hospital, measures such as providing transport for people to attend sessions and holding the sessions in different locations should be considered. Cardiac rehabilitation should be held in buildings that have access for disabled people.

Healthcare professionals should take into account the communication needs of people with chronic heart failure, including those with cognitive impairment, when delivering cardiac rehabilitation. All information should be culturally appropriate, and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. If needed, people should have access to an interpreter or advocate as set out in NICE's guideline on advocacy services for adults with health and social care needs.