Quality standard
Quality statement 4: Cardiac rehabilitation – assessment appointment
Quality statement 4: Cardiac rehabilitation – assessment appointment
Quality statement
Adults referred to a cardiac rehabilitation programme after a myocardial infarction (MI) have an assessment appointment within 10 days of discharge from hospital.
Rationale
Starting cardiac rehabilitation as soon as possible after a heart attack significantly improves ongoing attendance at cardiac rehabilitation programmes. Cardiac rehabilitation improves clinical outcomes and is cost saving through a reduction in unplanned re‑admissions for cardiac problems. An assessment appointment within 10 days of discharge ensures that people have contact with a member of the cardiac rehabilitation team as soon as possible. Because some people may not be able to drive or may not be ready for physical assessment within 10 days of discharge, this appointment can be an outpatient appointment, a home visit or a telephone interview.
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.
Structure
Evidence of local arrangements to ensure that adults referred to a cardiac rehabilitation programme after an MI have an assessment appointment within 10 days of discharge from hospital.
Data source: Local data collection.
Process
a) Proportion of referrals to a cardiac rehabilitation programme from hospital where the patient attends an assessment appointment within 10 days of discharge after an MI.
Numerator – the number in the denominator where the patient attends an assessment appointment within 10 days of discharge.
Denominator – the number of referrals to a cardiac rehabilitation programme from hospital after admission for an MI.
Data source: Local data collection. National data on adherence to cardiac rehabilitation are available from the British Heart Foundation National Audit of Cardiac Rehabilitation (NACR).
Outcome
Uptake rates of cardiac rehabilitation programmes.
Data source: Local data collection. National data on the uptake of cardiac rehabilitation are available from the British Heart Foundation National Audit of Cardiac Rehabilitation (NACR).
What the quality statement means for different audiences
Service providers (secondary and tertiary care services) ensure that adults referred to a cardiac rehabilitation programme after an MI can have an assessment appointment within 10 days of discharge.
Healthcare professionals ensure that adults referred to a cardiac rehabilitation programme after an MI have an assessment appointment within 10 days of discharge.
Commissioners commission services that have the capacity to give adults referred to a cardiac rehabilitation programme after an MI an assessment appointment within 10 days of discharge.
Adults referred to a cardiac rehabilitation programme after a heart attack have an appointment for an assessment within 10 days of leaving hospital. Starting cardiac rehabilitation as soon as possible encourages people to take part in the programme and makes it more likely that they will carry on.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendation 1.8.13
Definitions of terms used in this quality statement
Assessment appointment
An assessment appointment is the first session of a cardiac rehabilitation programme. The session includes advice on lifestyle and risk factors and an assessment of the person's cardiac function and suitability for different components of the programme. The assessment appointment can be an outpatient appointment, a home visit or a telephone interview.
Cardiac rehabilitation
Cardiac rehabilitation is defined as a coordinated and structured programme designed to remove or reduce the underlying causes of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that people can, by their own efforts, continue to play a full part in their community. A healthier lifestyle and slowed or reversed progression of cardiovascular disease can also be achieved. [NICE's full guideline on acute coronary syndromes]
Cardiac rehabilitation programmes should include a range of interventions with health education, lifestyle advice, stress management and physical exercise components. [NICE's guideline on acute coronary syndromes, recommendations 1.8.1 and 1.8.19]