Data from: Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland

OBJECTIVES: To determine why so few patients with chronic heart failure in England, Wales, and Northern Ireland take part in cardiac rehabilitation. DESIGN: Two-stage, postal questionnaire-based, national survey. PARTICIPANTS AND SETTING: Stage 1: 277 cardiac rehabilitation centres in England, Wales, and Northern Ireland registered on the National Audit of Cardiac Rehabilitation register in 2009–10. Stage 2: 35 centres that indicated in stage 1 that they provide a separate cardiac rehabilitation programme for patients with heart failure. RESULTS: Full data were available for 224/277 (81%) cardiac rehabilitation centres. Only 90/224 (40%) routinely offered phase 3 cardiac rehabilitation to patients with heart failure. Of these 90 centres that offered rehabilitation, 43% did so only when heart failure was secondary to myocardial infarction or revascularisation. Less than half (39%) had a specific rehabilitation programme for heart failure. Of those not providing for patients with heart failure, 134/224 (60%) considered a lack of resources and 89/224 (40%) exclusion from commissioning contracts as the reason for not recruiting patients with heart failure. Overall, only 35/224 (16%) centres provided a separate rehabilitation programme for people with heart failure. CONCLUSION: Patients with heart failure as a primary diagnosis are excluded from most cardiac rehabilitation programmes in England, Wales, and Northern Ireland. A lack of resources and direct exclusion from local commissioning agreements are the main barriers for not offering rehabilitation to patients with heart failure.研究目标：明确英格兰、威尔士及北爱尔兰地区仅少数慢性心力衰竭患者参与心脏康复（cardiac rehabilitation）项目的原因。研究设计：采用两阶段基于邮寄问卷的全国性调查。研究对象与研究场景：第一阶段：2009-2010年注册于《国家心脏康复审计登记册》（National Audit of Cardiac Rehabilitation register）的英格兰、威尔士及北爱尔兰的277家心脏康复中心。第二阶段：第一阶段中表明可为心力衰竭患者提供独立心脏康复项目的35家中心。研究结果：277家心脏康复中心中，224家（81%）可获取完整数据。其中仅90家（40%）常规为心力衰竭患者提供Ⅲ期心脏康复（phase 3 cardiac rehabilitation）服务。在这90家提供康复服务的中心中，43%仅在心力衰竭继发于心肌梗死或血运重建时才提供该服务。仅39%的中心拥有针对心力衰竭的专属康复方案。在未为心力衰竭患者提供康复服务的中心中，224家中的134家（60%）认为资源匮乏是主要阻碍因素，89家（40%）则指出未纳入委托服务合同（commissioning contracts）是无法纳入心力衰竭患者的原因。总体而言，仅224家中心中的35家（16%）可为心力衰竭患者提供独立的心脏康复项目。研究结论：在英格兰、威尔士及北爱尔兰地区，以心力衰竭为首要诊断的患者被排除在绝大多数心脏康复项目之外。资源匮乏以及被排除在本地委托服务协议之外，是导致无法为心力衰竭患者提供康复服务的两大主要障碍。