Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based and cost-effective intervention that helps patients manage their own condition in partnership with their healthcare professionals. Cardiac rehabilitation has consistently been demonstrated to significantly reduce morbidity, hospital admissions and mortality amongst patients with established cardiovascular disease(1-6) while also increasing their quality of life.(7,8)
The Model of Care for Integrated Cardiac Rehabilitation in Ireland was published in October 2023 heralding a new integrated approach to care delivery. To support implementation, an in-depth review of current national hospital and community CR services was completed to identify the resources, supports and staff training required.
Methodology: Under the governance of the Prevention Sub-Group of the National Heart Programme Clinical Advisory Group, a survey of all 63 cardiac rehabilitation services within the Irish public health service was conducted. The survey contained 41 questions on the following topics in relation to CR: phases I, II and III, referral processes, waiting times, documentation, staffing, staff training, service audit and evaluation, discharge processes, plus a site’s perceived barriers and enablers to the delivery of integrated cardiac rehabilitation within their service.
Results: The results demonstrate a crisis in current CR services within the Irish public health service and highlight areas for improvement:
- A 38% reduction nationally in cardiac rehabilitation staff between 2009 and 2024.
- A 61% reduction in hospital cardiac rehabilitation staff between 2009 and 2024.
- There is significant variation among recently established community CR sites in terms of readiness to deliver CR: 14 of 30 sites were not delivering a Phase III CR service at the time of the assessment.
- Waiting times for Phase III initial assessment varied from 2-96 weeks, with median minimum and max waiting times of 4 and 16 weeks.
- There is a lack of standardisation across all components related to service delivery, including the referral process and ability to offer patient choice; structure of Phase III; delivery of core education components; documentation e.g. operational templates and patient information resources; and activity audit and evaluation.
Implications:
- Identify national strategic support to address staffing deficits in cardiac rehabilitation (CR).
- Develop a standard national, evidence-based, quality-assured, person-centered CR program for Ireland.
- Deliver the CR program through in-person, online, or blended methods.
- Support ongoing development, evaluation, and training at local, regional, and national levels.
- Ensure sufficient resources and support for the successful implementation of integrated working in CR.
- Promote equitable access to CR services across Ireland.
References available on request.