Cardiac Rehabilitation and Secondary Prevention
Cardiovascular diseases (CVD; heart and circulatory diseases) contribute to 31% of all deaths worldwide, which is higher than any other cause. Cardiac Rehabilitation (CR) programmes are offered to people with heart disease to support them to continue with their lives after they have been interrupted by a cardiac event or diagnosis. These programmes have been shown to be effective and are delivered in the UK and internationally in line with clinical guidelines. CR includes psychosocial, educational, health behaviour change, and risk management elements. We are conducting three studies exploring different aspects of cardiac rehabilitation:
Effectiveness of social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease
There is evidence that social support or social network interventions can be effective in supporting people to make changes to their behaviour and to maintain these changes in the longer term. Harnessing the power of social networks to support people with CVD may be a useful approach used alongside traditional rehabilitation or secondary prevention programmes to enhance effectiveness, as low levels of social support are associated with increased risk of Coronary Heart Disease events, and social isolation and weak social networks have been linked to poor outcomes for individuals with heart disease.
Purcell, C. , Smillie, S. , Hilton Boon, M. , Simpson, S. A. and Taylor, R. S. (2021) Effectiveness of social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database of Systematic Reviews, 2020(12), CD013820. (doi: 10.1002/14651858.CD013820)
Implementation of an evidence based home cardiac rehabilitation programme for people with heart failure and their caregivers in Scotland (SCOT:REACH-HF)
Heart failure is a serious condition that affects nearly one million people in the UK, and its prevalence is increasing. Heart failure has significant impacts on quality of life and the cost of heart failure to the NHS is estimated at £2 billion annually.
Despite national guidelines recommending that everyone with heart failure should receive cardiac rehab (CR), currently only some 20% of patients with a diagnosis of heart failure are currently offered or participate. Most of what is offered is hospital-based, which has been found to be a barrier to participation. Home-based CR can provide an accessible and cost-effective approach to improving uptake and accessibility. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) trial found the addition of REACH-HF to usual medical care had a positive impact on participants living with heart failure and their caregivers.
SCOT:REACH-HF seeks to understand what shapes the implementation of the REACH-HF programme in a real-world setting. With six NHS ‘beacon sites’ across Scotland, we aim to inform the future implementation of this home-based programme for people with heart failure and their caregivers in Scotland. We are currently following up participants and the study as a whole concludes in July 2022.
SCOT:REACH-HF is funded by Heart Research UK.
The REACH-HF programme recently received its first NHS funding for roll-out in England.
Cardiac Rehabilitation Cochrane Review Centre
We are conducting a Cochrane systematic review which aims to assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. This review part funded by core funding and also by Heart Research UK will be published in 2022.
Since publishing our first Cochrane review of cardiac rehabilitation in 2000 our centre has produced and maintained covering cardiac rehabilitation and secondary prevention.
Our portfolio reflects
- the comprehensive nature of cardiac rehabilitation intervention (exercise, psychological support and education),
- the delivery of cardiac rehabilitation in different settings,
- the wider population of patients (post-myocardial, post-revascularisation, heart failure) receiving these services, and
- the broader nature of relevant clinical and policy outcomes (hospital admission, health related quality of life)
These Cochrane reviews have played , particularly in high-income country settings such as Europe and North America. Our aim in the next phase of our programme is to explore the translation of these interventions to low- and middle-income country settings, where home-based rehabilitation may be an affordable and sustainable model of care.