Third National Survey of Cardiac Rehabilitation Service Provision in Ireland: progress on the 1999 National Cardiovascular Health Strategy Recommendations

Background: The National Cardiovascular Health Strategy, including specific plans for cardiac rehabilitation, was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2006 to evaluate progress on service provision. Aim: To establish levels of service provision and service formats of cardiac rehabilitation services in 2005, compare them with the status pre-Strategy (1998) and to ascertain areas in which additional resources may be needed to achieve the 10 national recommendations for cardiac rehabilitation. Method: All hospitals in Ireland (n=37) admitting cardiac patients to a coronary or intensive care unit completed surveys by postal questionnaire or telephone follow-up. Results: All hospitals provided Phase I, 97% (36 hospitals) provided Phase II and 95% (35 hospitals) provided Phase III outpatient programmes. Forty–three percent (16 hospitals) provided a formal phase IV programme. Lack of staff (66%) and lack of available space (23%) were cited as the greatest barriers to programme development. Expanding the service to provide cardiac rehabilitation to other types of patient was deemed the most important area for development by 34% of centres. The development and provision of Phase III was prioritised by 39% while 18% prioritised the provision of Phase IV. Although professional input has increased substantially since 1998 (from a mean of 45.9 hours per week in 1998 to a mean of 135 hours per week in 2005, centres reported several concerns with staffing levels. Eleven cardiac rehabilitation centres were being run single-handedly by cardiac rehabilitation coordinators. There was also great variation in recommended multidisciplinary input across centres. Twenty-four centres had dedicated facilities with 10 sharing facilities. Thirty-one centres had an exercise area and 19 had a separate education area. Conclusions: There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past seven years. The next challenge is to ensure that all those who could benefit in each centre is provided with the opportunity to take part in all phases of Cardiac Rehabilitation.