Utilising observational data for cardiac rehabilitation: Impacting care using registry data

Cardiac rehabilitation (CR) is an established evidence-based intervention which reduces the risk of mortality, morbidity and can improve health related quality of life (HRQOL). In the UK CR service delivery and outcome are routinely evaluated through the National Audit of Cardiac Rehabilitation (NACR); a patient registry of those eligible for CR. Auditing of services facilitates the identification of practice inconsistency and inequalities or inequities that may otherwise go unnoticed. Several have been reported in the NACR annual statistical report, but what remains unknown is how this may impact patient outcome, a question which forms the basis for this programme of research. The overarching aim is to identify and better understand determinants of quality delivery and outcome and, where evident, promote positive service change for patient benefit. Specifically, I investigated how CR is currently utilised and what predicts initiation, how clinically effective current day CR is and what impact does CR timing and employment status have on patient outcome. A series of quantitative investigations were undertaken, including one systematic review and four separate data analyses using data from the NACR registry, each of which is presented in this thesis.

The research highlights the importance of adhering to clinical guidelines on service timing and the need to conduct and use information from rigorous pre-CR patient assessment. Aspects of this work have also fed into the NACR_British Association for Cardiovascular Prevention and Rehabilitation (BACPR) certification programme; a national initiative to drive service improvement. Overall this thesis serves as an exemplar of work on the utility of observational data i.e. registry-based analysis.