The electronic tracking of referral and attendance at cardiac rehabilitation in Counties Manukau Health: a potential model for New Zealand.

AIM: Cardiac rehabilitation (CR) programmes for patients surviving an acute coronary syndrome (ACS) event are important and recommended by clinical guidelines. Referral and attendance, however, remain suboptimal and tracking both of these aspects to inform quality improvement has been difficult. The aim of this study was to describe the use of an electronic registry to capture referral and attendance at CR in CMH and to report the characteristics of the initial cohort.

METHOD: We developed and implemented an electronic tracking tool, designed to be compatible with ANZAC-QI to monitor referral and attendance in a cohort of patients with confirmed ACS between 1 January 2013 and 1 January 2015.

RESULTS: Over 90% of patients with confirmed ACS had in-hospital phase 1 CR and three quarters were referred for post-discharge phase 2 CR. Of those with an ACS diagnosis, half attended at least one CR intervention but only a third completed their planned programme. Older patients and women were less likely to be referred for CR and those without in-hospital revascularisation, current smokers and with prior CVD were least likely to attend after referral.

CONCLUSION: Despite offering a range of CR options including community, clinic one on one and home based CR, the uptake of CR in patients with ACS remains suboptimal. An electronic tracking process was easy to use and has identified referral and attendance deficits that can be improved. Exploring new models of structured secondary prevention process, alongside encouraging referral and supporting attendance at established CR programmes, will offer benefits.