The role and evidence base for primary care in the provision of cardiac rehabilitation and
secondary prevention services
Despite good evidence that participation in cardiac rehabilitation can reduce cardiovascular
mortality and the risk of hospitalisation and improve patient health-related quality of life, the
referral, access and uptake of secondary prevention rehabilitation services across the UK remains
highly variable. In order to improve equity of provision, NICE commissioning guidance (CMG40) has
emphasised the need for an integrated approach to cardiac rehabilitation that spans across the care
pathway with greater involvement of primary care.
Since the mid-1990s, the South West has been at the forefront of primary care developments in
cardiac rehabilitation. The Cornish model of cardiac rehabilitation provision has been recognised and
accredited as a national beacon of primary care involvement. The CHARMS (Cornwall Heart Attack
Rehabilitation Management Study) randomised controlled trial was pivotal in demonstrating the
similarity in improvement in patient and clinical outcomes and costs of a primary care supported
home-based rehabilitation versus a traditional secondary care-based model. An ongoing NIHRfunded REACH-HF (Rehabilitation Enablement in Chronic Heart Failure) programme, jointly led by
Exeter and Truro, has developed de novo model of patient and carer self-directed rehabilitation care
in heart failure that is being currently evaluated in two trials.
In this presentation I will overview the rationale for increased primary care involvement in the
provision of cardiac secondary prevention and rehabilitation; discuss the key local, national and
international research in this area; and reflect on some of the key challenges and uncertainties
moving forward.