Evaluation of Cardiac Rehabilitation Quality and Outcomes

Purpose: The beneficial effects of cardiac rehabilitation (CR) have been challenged in recent years and there is now a need to investigate whether current CR programmes, delivered in the context of modern cardiology, still benefit patients. Huge variability in quality of service delivery of CR in the UK and patient outcomes has consistently been reported. The aims of this thesis are to assess the extent to which programmes meet standards for the delivery of CR and ascertain whether the variation in quality of CR delivery is determined by the CR attenders’ characteristics. Methods: Observational studies using data extracted and validated from the UK’s National Audit of Cardiac Rehabilitation (NACR). The quality of CR delivery was categorised into three groups: high, middle and low. Multinomial logistic regression models were used to test for predictors of high-quality delivery of CR. Results: 30.6% programmes were assessed as high quality, 45.9% as middle quality, and 18.2% as low quality. Conclusion: This thesis revealed that high levels of quality delivery are achievable in the era of modern cardiology. CR programmes need to pay greater attention to recruitment of patients who are more representative of the broader CVD population than those with few comorbidities. Future research is needed to investigate the extent to which patients meet outcomes targets among high-, middle- and low-quality CR programmes.