Concordance with phase‑one cardiac rehabilitation guidelines in the inpatient setting

Abstract

Objective: To examine concordance with phase‑one cardiac rehabilitation (CR) guidelines, undertake an intervention that might optimise adherence to the guidelines, and establish a benchmark for practice in the coronary care unit (CCU) setting.

Design: Pre‑post intervention medical record review.

Setting: Level 1, university-affiliated coronary care unit (CCU), Melbourne, Australia.

Subjects: Inpatients of the CCU with a discharge diagnosis of acute coronary syndrome, ischaemic‑induced acute pulmonary oedema, myocardial infarction, arrhythmia, or cardiac arrest, and patients for elective coronary interventions (eg. angioplasty).

Interventions: Medical record review of concordance with phase‑one CR guidelines and staff in‑services to communicate the results; distribution of a questionnaire post-in-service to collate staff perceptions of barriers to undertaking phase‑one CR; and repeated medical chart audit to re‑assess concordance.

Main outcome measures: Concordance with the guidelines for phase‑one CR.

Results: Data was complete for 89 cases. Concordance rates ranged from 5 to 100%. Good concordance with guidelines was recorded in advising the patient of their medical diagnosis (98‑100%); and in assessing the patient and their family’s psychological adjustment to their condition and the impact it had on their well-being (80‑83%). The only significant improvement post-intervention was a written invitation to a phase two CR program (5 vs. 14%).

Conclusions: The audit raised awareness of barriers to undertaking phase‑one CR but did not appreciably alter the concordance rates. This suggests other strategies and resources to increase the delivery of phase‑one CR need to be considered