Quality statement 7 (developmental): Options for cardiac rehabilitation

Developmental quality statements set out an emergent area of cutting‑edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.

Quality statement

Adults with chronic heart failure referred to a programme of cardiac rehabilitation are offered sessions during and outside working hours, and the choice of undertaking the programme at home, in the community or in a hospital setting. [new 2016]

Rationale

Programmes of cardiac rehabilitation can improve clinical outcomes and quality of life for people with chronic heart failure. People with chronic heart failure are typically older, and may be frail or have comorbidities. This can make it difficult for them to attend group‑based programmes at hospitals or clinics. Offering programmes of cardiac rehabilitation at different times of day and at different venues is likely to increase both uptake and adherence, and to improve patient experience.

Quality measures

Structure

Evidence of local arrangements to provide programmes of cardiac rehabilitation during and outside working hours, and the choice of undertaking programmes at home, in the community or in a hospital setting.

Data source: Local data collection.

Process

Proportion of people referred to a programme of cardiac rehabilitation who are offered sessions during and outside working hours, and the choice of undertaking the programme at home, in the community or in a hospital setting.

Numerator – the number in the denominator offered sessions during and outside working hours, and the choice of undertaking the programme at home, in the community or in a hospital setting.

Denominator – the number of adults with chronic heart failure referred to a programme of cardiac rehabilitation.

Data source: Local data collection.

Outcome

a) Rates of uptake of and adherence to programmes of cardiac rehabilitation.

Data source: Local data collection. National data on the uptake of cardiac rehabilitation are available from the National Audit of Cardiac Rehabilitation.

b) Patient experience of programmes of cardiac rehabilitation.

Data source: Local data collection. National data on the uptake of cardiac rehabilitation are available from the National Audit of Cardiac Rehabilitation.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GP practices, community nursing teams and hospitals) offer programmes of cardiac rehabilitation during and outside working hours, and the choice of undertaking the programme at home, in the community or in a hospital setting.

Healthcare professionals (such as GPs, cardiac rehabilitation nurses and specialists in cardiac care) offer adults referred to programmes of cardiac rehabilitation a choice of sessions during and outside working hours, and a choice of undertaking the programme at home, in the community or in a hospital setting.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) commission cardiac rehabilitation services that have the capacity to provide programmes during and outside working hours, and a choice of undertaking the programme at home, in the community or in a hospital setting.

What the quality statement means for patients, service users and carers

Adults with chronic heart failure offered a rehabilitation programme can choose to have their sessions at a time and place that suits them, such as during or outside working hours, and at a hospital or venue in their local area, or at home. This can help people to take part and continue to attend a programme.

Source guidance

Definitions of terms used in this quality statement

Programme of cardiac rehabilitation

This is an exercise‑based programme of rehabilitation designed for people with heart failure that includes a psychological and educational component.
[Adapted from Chronic heart failure in adults (NICE guideline CG108) recommendation 1.3.1.1]

Equality and diversity considerations

A programme of cardiac rehabilitation should be available for all adults with chronic heart failure, including those who may be house-bound or in a nursing home. To ensure equality of access to rehabilitation programmes, measures such as providing transport for people to attend sessions and holding the sessions in different locations should be considered. Cardiac rehabilitation should be held in centres that have access for disabled people.

Healthcare professionals should take into account the communication needs of people with chronic heart failure, including those with cognitive impairment, when delivering cardiac rehabilitation. All information should be culturally appropriate, and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. People should have access to an interpreter or advocate if needed.