Quality statement 4: Cardiac rehabilitation

Quality statement

People from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme are given a choice of times and settings for the sessions and are followed up if they do not attend.

Rationale

Cardiac rehabilitation programmes improve clinical outcomes for people who have had a cardiac event. However, uptake among people from black, Asian and other ethnic minority groups is lower than in the general population. Providing programmes that are culturally appropriate and sensitive, at settings and times that are convenient can increase uptake. Following up people who do not attend allows for a discussion about potential barriers to attendance and how to overcome them. It also gives the opportunity to motivate people to start or to continue with the programme.

Quality measures

Structure

a) Evidence of local arrangements to discuss any factors that might stop people from black, Asian or other minority ethnic groups from attending a cardiac rehabilitation programme, before they receive a referral.

Data source: Local data collection, for example, from service level agreements.

b) Evidence of local arrangements to provide cardiac rehabilitation sessions for people from black, Asian and other minority ethnic groups in a variety of settings including at home, in the community or in a hospital.

Data source: Local data collection, for example, from service level agreements.

c) Evidence of local arrangements to provide cardiac rehabilitation sessions for people from black, Asian and other minority ethnic groups at a choice of times, for example, sessions outside working hours.

Data source: Local data collection, for example, from service level agreements.

Process

a) Proportion of people from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme who are offered sessions in a variety of settings including home, the community or a hospital.

Numerator – the number in the denominator offered sessions in a variety of settings including home, the community or a hospital.

Denominator – the number of people from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme.

Data source: Local data collection, for example, from patient records.

b) Proportion of people from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme who did not start the programme who were contacted with a reminder.

Numerator – the number in the denominator who were contacted with a reminder.

Denominator – the number of people from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme who did not start the programme.

Data source: Local data collection, for example, from patient records.

c) Proportion of people from black, Asian and other minority ethnic groups who missed their cardiac rehabilitation appointment who were contacted with a reminder.

Numerator – the number in the denominator who were contacted with a reminder.

Denominator – the number of people from black, Asian and other minority ethnic groups participating in a cardiac rehabilitation programme who missed their appointment.

Data source: Local data collection, for example, from patient records.

Outcome

a) Rate of uptake of cardiac rehabilitation programmes among people from black, Asian and other minority ethnic groups.

Data source: National data on the uptake of cardiac rehabilitation are available from the British Heart Foundation's National audit of cardiac rehabilitation. Local data collection, for example, from cardiac rehabilitation programme data collection system.

b) Rates of adherence to cardiac rehabilitation programmes among people from black, Asian and other minority ethnic groups.

Data source: National data on the uptake of cardiac rehabilitation are available from the British Heart Foundation's National audit of cardiac rehabilitation. Local data collection, for example, from cardiac rehabilitation programme data collection system.

c) Service user experience among people from black, Asian and other minority ethnic groups who accessed cardiac rehabilitation programmes.

Data source: Local data collection, for example, surveys carried out with people referred to cardiac rehabilitation.

What the quality statement means for different audiences

Service providers (secondary and tertiary care services) ensure they provide individualised support for people from black, Asian and other minority ethnic groups to attend and continue with cardiac rehabilitation programmes. This may include working on overcoming barriers with people who are not willing to engage with services due to poor past experiences or ensuring that the programmes are run on different days, at different times and at venues that are culturally appropriate and convenient. Providers also ensure that a varied range of acceptable and culturally sensitive exercise is available, and people are followed up to continue with the programme.

Healthcare professionals (such as cardiologists and cardiac nurses) identify barriers to attending a cardiac rehabilitation programme and offer individualised support to people from black, Asian and other minority ethnic groups. They offer cardiac rehabilitation programmes on different days, at different times and venues (such as community centres or places of worship) and ensure that they are culturally appropriate and suitable. Healthcare professionals also follow-up people to motivate them to continue with the programme or understand the obstacles that may prevent people from using the service.

Commissioners (clinical commissioning groups) commission cardiac rehabilitation services that have the capacity and expertise to provide people from black, Asian and other minority ethnic groups with programmes that are suitable, acceptable and culturally appropriate. They also ensure that the services support people from black, Asian and other minority ethnic groups to attend and adhere to the programme by addressing the barriers to participation.

People from black, Asian and other minority ethnic groups referred to a cardiac rehabilitation programme are supported to attend and keep going to the sessions. This might mean that sessions are available at venues and times convenient to the person or that the sessions are acceptable to them culturally, for example, single sex or with bilingual staff.

Source guidance

Definitions of terms used in this quality statement

Cardiac rehabilitation

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 and through improved health behaviour, slow or reverse progression of the disease. Cardiac rehabilitation should consist of a multidisciplinary, integrated approach delivering care in lifestyle risk factor management, psychosocial health, medical risk factor management and the optimal use of cardioprotective therapies, underpinned by psychologically informed methods of health behaviour change and education.

Cardiac rehabilitation programmes should include a range of interventions with health education, lifestyle advice, stress management and physical exercise components.

[NICE's guideline on myocardial infarction, full guideline and recommendations 1.1.1 and 1.1.19]

Equality and diversity considerations

Due to language and communication difficulties, or past experiences of racism and prejudice, some people from the black, Asian and other minority ethnic groups may find it difficult to engage with services. Also, some traditions and religious practices may stop people from accessing services on certain days or certain times of the day. Behaviour change programmes need to acknowledge those differences, be culturally appropriate, accessible and tailored to the diverse needs of the local population.