Cardiac rehabilitation services
This guide for commissioners is a resource to assist commissioners, clinicians and managers to commission high-quality and evidence-based services across England.
- Section 1 makes the case for commissioning cardiac rehabilitation services
- Section 2 an integrated approach to commissioning high-quality cardiac rehabilitation services
- Section 3 helps you assess local service levels
- Section 4 describes service components
- Section 5 makes suggestions for contract specification
- Section 6 explains more about the cost impact of service redesign
- Section 7 signposts to further information
NICE guidance provides evidence based recommendations about clinically effective and cost-effective treatments and interventions to improve health outcomes for individuals and local populations. Making commissioning decisions based on the best available evidence such as NICE guidance and accredited information from NHS Evidence can help commissioners ensure that they are using their resources effectively.
This guide for commissioners should be read together with the following NICE guidance and quality standard:
- NICE clinical guideline 172 Myocardial infarction (MI) - secondary prevention
- NICE clinical guideline CG94 Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction
- NICE clinical guideline CG108 Chronic heart failure: management of chronic heart failure in adults in primary and secondary care
- NICE quality standard for Chronic Heart Failure
This guide for commissioners provides advice on commissioning cardiac rehabilitation services. For the purposes of this guide for commissioners the following conditions are considered within the benchmark for cardiac rehabilitation (see section 3 for further information):
- myocardial infarction (MI) (ST-segment-elevation myocardial infarction (and non-ST-segment-elevation myocardial infarction)
- chronic heart failure
- unstable angina
- coronary artery bypass graft (CABG)
- angioplasty/percutaneous coronary intervention (PCI)
- Implantable Cardiac Defibrillators (ICD)
This guide for commissioners does not provide advice on commissioning cardiac rehabilitation for people with stable angina, or following Cardiac Resynchronization therapy (CRT), heart transplants, valve surgery or ventricular assist devices (see section 3 for further information).
This guide for commissioners on cardiac rehabilitation services updates and replaces the previous NICE commissioning guide on commissioning a cardiac rehabilitation service published in 2008 to reflect the NICE quality standard for chronic heart failure and changes to recommendations within NICE clinical guideline CG108 on chronic heart failure.
This guide for commissioners is complementary to The Department of Health´s commissioning pack on cardiac rehabilitation published in 2010 and which is also based on NICE clinical guidelines.
This guide for commissioners highlights any recommendations supporting cases for disinvestment or decommissioning by identifying treatments and interventions that do not add value, enabling commissioners to release resources or generate savings where appropriate.
Implementation of the guidance noted above is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement this guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in the guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
We are keen to improve NICE guides for commissioners in order to better meet the needs of commissioners. Please send us your ideas for future guides or other comments.
Read the NICE disclaimer for information on the use and accuracy of content on the NICE website.
A topic advisory group was established to review and advise on the content of the guide for commissioners, details of membership can be found in section 8.
Date of publication: November 2013
This page was last updated: 13 November 2013