7th June 2019, Volume 132 Number 1496

Brendon H Roxburgh, Marta Supervia, Karam Turk-Adawi, Jocelyne R Benatar, Francisco Lopez Jimenez, Sherry L Grace

Cardiovascular diseases (CVD) account for approximately 10,000 deaths per annum (31.2% of all deaths) in New Zealand.1 Patients afflicted with CVD are at increased risk of recurrent cardiovascular events and…

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Summary

Cardiac rehabilitation (CR) is a cost-effective service to improve risk factors after a heart attack and/or cardiac surgery, reducing mortality and risk of rehospitalisation. We compared the nature of CR programs in New Zealand and with those of countries with similar incomes and health systems. We found New Zealand CR programmes had fewer types and number of staff, provided fewer sessions and were less comprehensive, compared to those in other high-income countries. New Zealand did well in providing alternate forms of CR, such as community based.

Abstract

Aim

To compare the nature and delivery of cardiac rehabilitation (CR) services within New Zealand by island (North vs South; NI, SI), and to other high-income countries (HICs).

Method

In this cross-sectional study, secondary analysis of an online survey of CR programmes globally was undertaken. Results from New Zealand were compared to data from other HICs with CR.

Results

Twenty-seven (62.7%) out of 43 CR programmes in New Zealand (n=18/31, 66.7% respondents from NI) and 619 (43.1%) from 28 other HICs completed the survey. New Zealand CR programmes offered a median of 16.0 sessions/patient (interquartile range (IQR)=12.0–36.0; vs 21.6 sessions in other HICs, IQR=12.0–36.0, p=0.016), delivered by a team of 6.0 staff (IQR=5.5–7.0; vs 7.0 staff; IQR=5.0–9.0, p=0.012). New Zealand programmes were significantly less comprehensive than other HICs (p=0.002); within New Zealand, NI programmes were more likely to provide an initial and end-of-programme assessment, supervised exercise training and depression screening, compared to SI programmes (all p<0.05). New Zealand more often offered CR in an alternative setting (n=14, 58.3%), compared to other HICs (n=190, 36.5%), p=0.03).

Conclusion

CR programmes in New Zealand offer fewer sessions and have fewer elements compared to other HICs, and disparity exists in programmes across New Zealand. More investment is needed to ensure CR in New Zealand meets international guidelines.

Author Information

Brendon H Roxburgh, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin; Marta Supervia, Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States; Karam Turk-Adawi, Department of Public Health, QU Health, Qatar University, Doha, Qatar; Jocelyne R Benatar, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Francisco Lopez Jimenez, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States; Sherry L Grace, School of Kinesiology and Health Science, York University; University Health Network, University of Toronto, Toronto, Ontario, Canada.

Acknowledgements

On behalf of the International Council of Cardiovascular Prevention and Rehabilitation through which this study was undertaken, the Global CR Program Survey Investigators are grateful to all other national champions who collaborated to identify and reach programmes in other HICs, namely Drs Karl Andersen, Birna Bjarnason Wehrens, Vilnis Dzerve, Stefan Farsky, Hareld Kemps, Anna Kiessling, Evangelia Kouidi, Maria Mooney, Lis Neubeck, Bruno Pavy, Attila Simon, Eliska Sovova, Juan Castillo Martin, Jacqueline Cliff, Susan Dawkes, Eva Prescott and Egle Tamuleviciute-Prasciene. We also thank the CSANZ Secondary Prevention Working Group for assisting with programme identification and the World Heart Foundation who formally endorsed the study protocol.

Correspondence

Prof Sherry L Grace, School of Kinesiology and Health Science, York University; University Health Network, University of Toronto, 4700 Keele Street, Toronto, ON, Canada.

Correspondence Email

sgrace@yorku.ca

Competing Interests

Nil.

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