The number of people engaging with life-enhancing cardiac rehabilitation clinics has declined during the pandemic, according to a BMJ clinical update which makes the case for more home-based and virtual alternatives.
Before the covid-19 pandemic, 100,000 people were admitted to hospital with heart attacks and approximately 200,000 were diagnosed with heart failure annually in the UK. There was a 40% decline in the number of patients admitted with heart attacks (acute coronary syndromes ) in 2020.
Cardiac rehabilitation is crucial to helping people who have encountered a heart attack or heart failure have a better quality of life. Now, a new review, undertaken by cardiac rehabilitation experts based at the Universities of Exeter, Glasgow and York and published in the BMJ, reports that the number of people with heart failure attending UK clinics dropped from an already low ten per cent (4,969 patients) of those eligible pre-pandemic, to just five per cent (1,474). The review attributes the drop to many vulnerable people shielding, and many rehabilitation clinics closing during this period because of staff redeployment to respond to the pandemic.
A British Heart Foundation (BHF) National Audit of Cardiac Rehabilitation COVID-19 analysis published in 2020 mirrored other cardiac audits, showing a 30-40 per cent decrease in use of cardiology and rehabilitation services due to the pandemic compared with a similar period in 2019.
However, the number of people taking up home-based rehabilitation options has more than trebled over the same time period, rising from 22 to 74 per cent - strengthening the case for the use of more evidence-based programmes in this field to be rolled out.
Dr Hasnain Dalal, of the University of Exeter, co-authored the review.
Cardiac rehabilitation can enhance quality of life and reduce unplanned hospital admissions, yet uptake has been low, and has plummeted throughout the pandemic, creating a backlog. We know that home-based cardiac rehabilitation can work well for patients, and COVID-19 has provided an opportunity to reimagine how we delivery rehabilitation. Offering patients a choice of rehabilitation in clinics or at home - or a combination of both could help improve the numbers who can participate in the future".
Dr Hasnain Dalal
The review authors are part of the team behind the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) programme. The home-based programme for rehabilitation following heart failure was developed by a collaboration involving several clinical and academic partners across the UK including the Universities of Birmingham, Dundee, Exeter, Glasgow, Plymouth and York together with the Aneurin Bevan University Health Board, NHS Lothian, Ninewells Hospital & Medical School, Dundee, Royal Cornwall Hospitals NHS Trust, Sandwell and West Birmingham Hospitals NHS Trust ,University Hospitals of Leicester NHS Trust and York Hospitals NHS Foundation Trust.
The REACH-HF collaboration has received research and implementation funding past and present from a number of research funders and charities including: the National Institute for Health Research (NIHR), the British Heart Foundation (BHF), Heart Research UK, and the South West Academic Health Sciences Network.
This review comes after a major national trial found the programme was cost-effective and led to significant improvements in health-related quality of life. The REACH HF Team won the 2020 BMJ award in the stroke and cardiovascular category. http://thebmjawards.bmj.com/showcase/
Dalal, H.M., et al. (2021) Virtual and in-person cardiac rehabilitation. BMJ. doi.org/10.1136/bmj.n1270.