Promoting Excellence in Cardiovascular Disease Prevention and Rehabilitation
The BACPR
Standards and Core Components for
Cardiovascular Prevention and
Rehabilitation
Overview
 Aim of the BACPR Standards and Core
Components
 Background and evidence
 Introducing to the 2012 update of the BACPR
Standards and Core Components
 Shaping future service delivery
Aim
This second edition of the BACPR
Standards and Core Components
aims to ensure programmes are
clinically-effective, cost-effective
and achieve sustainable health
outcomes for patients.
7 core standards and 7 core components
are set out which aim to improve uptake
and quality of rehabilitation programmes
nationwide
www.bacpr.com
Cardiac Rehabilitation
defined by the WHO (1993)
“The sum of activities required to influence
favourably the underlying cause of the disease so
that (people) may, by their own efforts preserve
or resume when lost, as normal a place in the
community…
…it must be integrated within secondary
prevention services of which it forms one facet.”
The World Health Organisation (WHO). Cardiac rehabilitation and secondary prevention: long
term care for patients with ischaemic heart disease. Briefing letter. Regional office for Europe:
Copenhagen, Denmark; 1993.
Modern cardiovascular
prevention and rehabilitation
Modern CR is menu-based and patient centred, and provides a
pathway across the 7 stages from diagnosis to long term management.
2
5
Conduct final CR
assessment
Assess patient
Patient
presentation
0
Identify and refer
patient
1
Manage referral
and recruit patient
Patient discharged
4
Deliver
comprehensive
*CR programme
3
Develop patient
care plan
6
Discharge and
transition to long
term management
Sharing cardiac rehabilitation information (education) and long-term management strategy with the patient
*CR = cardiac rehabilitation
*From DH Commissioning Pack: Service specification for cardiac rehabilitation 2010
The benefits of cardiac rehabilitation
Reduces:




All cause mortality by 11- 26% 1,2,3
Cardiac mortality by 26 – 36% 1,2,3
Morbidity 3,4
Unplanned admissions by 28 -56% 5,6
Improves:
 Quality of life 7
 Functional capacity 7
Supports:
 Early return to work 7
 The development of self-management skills 7
www.bacpr.com
Cardiac Rehab is Cost Effective
Cost to achieve adding 1 year to a patients life
– PPCI
– PCI
– CABG
– Cardiac Rehab
– Aspirin/B-block
£6,054 – 12,057
£3,845 – 5,889
£3239 – 4,601
£1,957
<£1,000
Fidan et al 2007
The future for CR
Summary 1
 CR is one of the most clinically and
cost-effective therapeutic interventions in cardiovascular
disease management
 More living and surviving with CVD or heightened risk of
CVD
 Increased survival from CHD events means greater
numbers with heart failure in future
 CR shifting from a “survival of the fittest” goal (reduced
mortality) to one of prevention, chronic disease
management and morbidity reduction
UK Standards for CR – a brief history
 Number of cardiac rehabilitation programmes
expanded rapidly during 1980s and 90s
 BACR formed in 1992 and recognised the
importance of establishing guidelines for good
practice – 1995 publication of BACR
Guidelines for CR.
BACR Standards 2007
Core components:
 Lifestyle:
 Physical activity and exercise
 Diet and weight management
 Smoking cessation
 Education
 Risk factor management
 Psychosocial
 Cardio protective drug
therapy and implantable
devices
 Long-term management
strategy
British Association for Cardiac Rehabilitation (BACR), Standards and Core Components for Cardiac Rehabilitation (2007).
Date of Preparation: September 2009
OMA624
The NHS for the future
 Has to save money, not just be more cost
effective
 Our goals for Cardiac rehab must include
 Preventing hospital re-admissions
 Preventing unnecessary appointments in primary care
 Educated patients knowing who to contact if
symptoms or condition changes
 A focus on managing chronic disease linked with or
causing CVD
Changes to the
Standards and Core Components
 Emphasis on:
Patient-centred approach
Biopsychosocial focus
Multidisciplinary team work
Health behaviour change and
Education at core of all components
– Recognition of the importance of
audit and evaluation
– Matched to DH Commissioning pack
for CR
–
–
–
–
BACPR Standards 2012
Patients, healthcare professionals and commissioners should expect the following from
high quality cardiac rehabilitation services
1. The delivery of seven core components employing an evidence-based
approach.
2. An integrated multidisciplinary team consisting of qualified and competent
practitioners, led by a clinical coordinator.
3. Identification, referral and recruitment of eligible patient populations.
4. Early initial assessment of individual patient needs in each of the core
components, ongoing assessment and reassessment upon programme
completion.
5. Early provision of a cardiac rehabilitation programme, with a defined pathway
of care, which meets the core components and is aligned with patient
preference and choice.
6. Registration and submission of data to the National Audit for Cardiac
Rehabilitation.
7. Establishment of a business case including a cardiac rehabilitation budget which
meets the full service cost.
Seven Core Components
1. Health behaviour change and
education
2. Lifestyle risk factor management
– Physical activity and exercise
– Diet
– Smoking cessation
3.
4.
5.
6.
7.
Psychosocial health
Medical risk factor management
Cardioprotective therapies
Long-term management
Audit and evaluation
The future for CR
Summary 2
Ensuring referral of all eligible patients by cardiologists and/or specialist
cardiovascular health care physicians to a prevention and rehabilitation
programme as a standard (not optional) policy that is held in the same regard as
the prescribing of cardioprotective medications.
Tighter control of service audit (e.g. through NACR), not only to ensure these
standards and core components are being met but to demonstrate that
improved practice, clinical effectiveness and health outcomes have been achieved
The continuing of a national campaign that raises the profile and need for
comprehensive integrated cardiovascular prevention and rehabilitation
programmes to be properly funded as a cost-effective means and obligatory
element to any modern cardiology or vascular health care service.
BACPR’s next steps
 Develop a set of performance indicators for the standards.
 Provide resources for service development e.g. tool-kits for
business case development, exemplary assessment frameworks
and mechanisms for effective knowledge transfer and training.
 Developing competency frameworks that are fully supported by
high quality education and training programmes and research
where required.
• Support the uptake of CR in groups that are currently not
represented or are under-represented
• Edit a book from BACPR giving more detail on the “how to” of
providing modern CR programmes.
References from slide 4
1. Heran et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane
Database of Systematic Reviews 2011, Issue 7. Art. No: CD001800. DOI:
10.1002/14651858.CD001800.pub2.
2. Taylor et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic
review and meta-analysis of randomized controlled trials. Am J Med 2004; 116(10):682-697.
3. Lawler et al. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: A
systematic review and meta-analysis of randomized controlled trials. Am Heart J Oct 2011;
162: 571-584.
4. Clark et al. Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery
Disease. Ann Intern Med 2005; 143(9): 659-672.
5. Lam et al. The effect of a comprehensive cardiac rehabilitation program on 60-day hospital
readmissions after an acute myocardial infarction. J Am Coll Cardiol 2011; 57:597,
doi:10.1016/S0735-1097(11)60597-4.
6. Davies et al. Exercise training for systolic heart failure: Cochrane systematic review and metaanalysis. Eur J Heart Fail 2010; 12(7): 706-715.
7. Yohannes et al.. The long-term benefits of cardiac rehabilitation on depression, anxiety,
physical activity and quality of life. Journal of Clinical Nursing 2010; 19(19-20):2806-2813.