Patient Education and Secondary Prevention Research Program

CONNECT-CR: Increasing the uptake of cardiac rehabilitation through improving recommendation, referral and continuity of care for cardiac patients and families in Victoria

A two-phase project involving co-design of and intervention, followed by user testing, funded by Monash University's Rehabilitation, Ageing and Independent Living (RAIL)

Chief Investigators

Dr Susie Cartledge, Dr Li Li, Dr Christina Ekegren, Prof Andrea Driscoll, A/Prof Dion Stub

Estimated completion date

October 2023

Background

Uptake of cardiac rehabilitation (CR) programs in Australia is poor, with only 30% of eligible cardiac patients attending. These programs comprising supervised exercise, education, and psychosocial support significantly reduce mortality and hospital readmissions, and improve quality of life. Complex drivers underpin under-attendance, with lack of awareness about the benefits, and fragmented systems of care between inpatient and outpatient cardiac care chief among them.

There are currently no Australian studies or strategies to improve uptake of CR, therefore this study will provide essential national data. This study fills that gap and involves cardiac patients, health care professionals (HCPs) and policy-makers in the co-design process to maximise relevance and engagement.

Aim

We are co-designing and testing a digital intervention that aims to improve adherence by guiding initial introductory CR (education, support and gentle physical activity) and increasing continuity of care between discharge and commencement of an outpatient CR program.

Methods

The digital intervention will be co-designed with consumers, health care professionals and policy makers. It will then be developed through a collaboration with Monash Faculty of IT and user tested.

Status and key findings to date

Phase I was completed in October 2022, identifying three main themes which were aligned between patients and HCPs: illness experience (emotional factors, value of peer support); information (difficulty finding information, absence of clear plan); and the system (lack of patient empowerment, CR access challenges). Patients articulated the need for an intervention that provides a clear plan, trusted information and is potentially augmented by personalised support through a phone call with an HCP.

Outputs to date

Cartledge S, Nourse R, Ekegren C, Li L, Driscoll A, Stub D. Development of a Transition of Care Intervention for Acute Coronary Syndrome to Increase Continuity of Care and Uptake of Cardiac Rehabilitation: A Co-Design Study. Heart Lung and Circulation. 2022 Jan;31(3):735-9. doi: 10.1016/j.hlc.2022.06.495.

Trends and Predictors of Cardiac Rehabilitation Referral Following Percutaneous Coronary Intervention

A data analysis project using data from the Victorian Cardiac Outcomes Registry, published in September 2022

Percutaneous Coronary Interventions (PCI) are minimally invasive procedures used to open clogged coronary arteries, relieving symptoms of blocked arteries including chest pain and shortness of breath. Following PCI, outpatient cardiac rehabilitation (CR) is essential for secondary prevention. Despite many proven benefits, uptake of CR is low, with only 30% of eligible cardiac patients attending in Australia.

This analysis sought to identify contemporary trends and predictors of CR referral of PCI patients in Victoria.

Key output

Cartledge S, Driscoll A, Dinh D, O'Neil A, Thomas E, Brennan AL, Liew D, Lefkovits J, Stub D. Trends and Predictors of Cardiac Rehabilitation Referral Following Percutaneous Coronary Intervention: A Prospective, Multi-Site Study of 41,739 Patients From the Victorian Cardiac Outcomes Registry (2017-2020). Heart Lung Circ. 2022 Sep;31(9):1247-1254. doi: 10.1016/j.hlc.2022.04.050. Epub 2022 May 25.

Projects with SOLVE-CHD

SOLVE-CHD is a five-year program of work to transform post-discharge secondary prevention and reduce the burden of heart disease by decreasing deaths, hospitalisations and costs via a program of work that integrates data, technology, partnerships and capacity building. We work with SOLVE-CHD on the following projects:

• National cardiac rehabilitation (CR) data management survey
• An MRFF project examining CR clinical quality improvement with a clinical quality data collection platform
• Co-design of mental health and lifestyle intervention
• Examination of funding in cardiac rehab programs

Projects with the Australian Cardiovascular Health and Rehabilitation Association (ACRA)

ACRA is the peak body which provides support and advocacy for multidisciplinary health professionals to deliver evidence-based best practice across the continuum of cardiovascular care. We work with them on the following projects:

• Victorian COVID impact on CR focus group
• National CR COVID impact survey
• National CR use of telehealth during COVID
• Queensland COVID CR and pulmonary rehabilitation telehealth examination

Dr Cartledge also serves as Co-Chair of the Cardiac Rehabilitation section of ACRA and Cardiac Society of Australia and New Zealand’s joint Position Statement on Telehealth, Remotely-delivered Cardiovascular Care and Cardiac Rehabilitation.