Quality standard
Quality statement 5 (developmental): Options for cardiac rehabilitation
Quality statement 5 (developmental): Options for cardiac rehabilitation
Developmental quality statements set out an emergent area of cutting‑edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.
Quality statement
Adults referred to a cardiac rehabilitation programme after a myocardial infarction (MI) are offered sessions during and outside working hours and the choice of undertaking the programme at home, in the community or in a hospital setting.
Rationale
Cardiac rehabilitation programmes improve clinical outcomes for people who have had an MI. Offering cardiac rehabilitation programmes at different times of day and at different venues is likely to increase both uptake and adherence and to improve patient experience. It is important that programmes are provided outside normal working hours, so that they are accessible to people who work and to those with other commitments during the day.
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 provide cardiac rehabilitation programmes during and outside working hours and the choice of undertaking programmes at home, in the community or in a hospital setting.
Data source: Local data collection.
Process
Proportion of people referred to a cardiac rehabilitation programme who are offered sessions during and outside working hours and the choice of undertaking the programme at home, in the community or in a hospital setting.
Numerator – the number in the denominator offered sessions during and outside working hours and the choice of undertaking the programme at home, in the community or in a hospital setting.
Denominator – the number of people referred to a cardiac rehabilitation programme after an MI.
Outcome
a) Rates of uptake of and adherence to cardiac rehabilitation programmes.
b) Patient experience of cardiac rehabilitation programmes.
Data source: Local data collection. National data on the uptake of cardiac rehabilitation are available from the British Hearth Foundation National Audit of Cardiac Rehabilitation (NACR).
What the quality statement means for different audiences
Service providers (secondary and tertiary care services) offer cardiac rehabilitation programmes during and outside working hours and the choice of undertaking the programme at home, in the community or in a hospital setting.
Healthcare professionals offer adults referred to cardiac rehabilitation programmes a choice of programmes during and outside working hours, and a choice of undertaking the programme at home, in the community or in a hospital setting.
Commissioners commission cardiac rehabilitation services that have the capacity and expertise to provide programmes during and outside working hours and the choice of undertaking the programme at home, in the community or in a hospital setting.
Adults referred to a cardiac rehabilitation programme can choose a programme in the daytime or outside working hours, at a hospital, in the local area or at home. Having a choice of time and place means that they are more likely to be able to take part in a programme.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendations 1.8.1 and 1.8.9
Definitions of terms used in this quality statement
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]