Cardiac Rehabilitation Secondary Prevention Referral and process review Hazel Mountford, Abbey Sawyer & Madeline Gaynor Physiotherapy Department Sir Charles Gairdner Hospital, Western Australia

Briffa et al 2011,ACSQHC 2014, Dalal et al 2015 Background ↑ Prevalence coronary heart disease & heart failure Cardiac Rehabilitation Secondary Prevention (CRSP) is effective but <50% participation In WA 43% of all cardiac events are recurrences Acute Coronary Syndrome (ACS) Clinical Care Standard SCGH hospital-based program ACS is 60% of referrals Briffa et al 2011,ACSQHC 2014, Dalal et al 2015

Aim To audit and compare the proportion of ACS patients referred to the SCGH hospital-based CR program in 2015-16 and 2016-17

Sir Charles Gairdner Hospital (SCGH) Tertiary hospital (>600 beds, 420,000 pts/yr) 1 Cath lab, 3 theatres, 30-40 beds Process: automatic referral for all ACS to CR Coordinator (CNC). Triages referrals: SCGH CR program, private program, community service, regional/other tertiary hospital CR Multidisciplinary team: Nurses, Physiotherapists, Pharmacist, Dietician (private).

Method: audit design Retrospective audit and process evaluation 2015 ACS referral number data collection (retrospective): Clinical codes Admissions/Discharges Number of referrals Referral process review 2016 Implement recommended changes Re-audit and monitor 2017

Results table1. 2015-16 2016-17 Total number of ACS patients ACS referrals to CR Coordinator N = 928 832 (89%) N = 770 648 (84%) Triage destination Hospital-based CR program 240 29% 174 27% Rural CR program 207 22% 172 26% Community/other CR programs 73 9% 258 40% Total number of ACS referrals to CR 520 63% 604 93% Declined CR 92 11% 72 Incomplete data 220 95 15%* * Chi square, p<0.05

Summary – results Referrals to any CR program improved from 63% to 93% Missed/incomplete referrals was reduced from 27% to 15%

Discussion Main points from the re-audit data were: More ACS patients from SCGH are referred to community CR programs compared to 2015-16 We can infer a higher number of ACS patients were able to access CR in 2016-17 (distance/cost) Incomplete data can go undetected. Audits are necessary to identify if you meet Clinical Care Standards Efforts to standardise terminology on referrals and recognition referrals are data  decrease in referrals being missed/incomplete

Limitations: Heart Failure and Cardiothoracic referrals were beyond the scope of this audit Recommendation: In the future, CR database (referrals) to link to hospital admission and discharge system Audit attendance / uptake of CR by patients following referral to a program

SCGH ACS data <90% referred 60% attend 75-80% complete

Acknowledgements No conflicts of interest to declare. I was supported by: Abbey Sawyer, Madeline Gaynor, Nola Cecins & Sue Jenkins, and SCGH Physiotherapy Department. SCGH CR & HF teams. No conflicts of interest to declare.

References Australian Commission on Safety and Quality in Health Care. Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC, 2014. Dalal HM, Doherty P and Taylor RS. Cardiac Rehabilitation. BMJ 2015; 351:h5000. Briffa TG, Hobbs MS, Tonkin A, Sanfilippp FM, Ridout SC and Knuiman M. Population Trends of Recurrent Coronary Heart Disease Event Rates Remain High. Circulation: Cardiovascular Quality and outcomes. 2011; 4: 107-113.

Appendice

FY 2015-16 2016-17 ? Our responsibility

Plus community cardiac rehab programs! Three NEW hospitals Fiona Stanley (20, 24 beds) Midland SJOG (caths) Joondalup (10, 8)

ACS management in WA Emergency/elective ACS treatment Tertiary hospital Private hospital Cardiac Rehab & Secondary Prevention Tertiary or secondary hospital program (catchment) Community program (public health) Private program (private health fund) Rural and remote (Regional hospital or partial local service +/- tertiary hospital education/support) Interstate and international

Terminology “Exercise discussed… [name] reports walking the dog 20minutes twice a day… Agreed to referral to physiotherapist/Community program…” “Agreed to referral to Albany CR program… Agreed to follow-up phone education…” “Discussed benefits of exercise with [name]… patient declined referral to CR .. States he already exercises more than 30 minutes each day… and completed CR in 2012…”