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An Evaluation of the National Audit of
Cardiac Rehabilitation (NACR) for adults
with Heart Failure (2013-2017)
1 National Centre for Sport and Exercise Medicine (NCSEM),
School of Sport, Exercise and Health Sciences, Loughborough
University2Centre for Exercise Rehabilitation Sciences (CERS),
University Hospital Leicester
3Department of Health Sciences, University of York
BACPR Annual Conference, 6th October 2017
A V Jones 1,2, A Harrison 3, L Sherar 1, R Evans 2, P Doherty
3*, S Singh 1,2*
* Joint last authors
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Overview
• Background
• Aim & Methods
• Results
• Study limitation
• Conclusion
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Background
• Exercise rehabilitation is
advised in the management
of adults with stable heart
failure
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Version 1 (Protocol paper)
40.87m
All cause mortality SAME
Hospital admission
Long term mortality
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Aim• To investigate the change in outcome measures of heart
failure patients in the UK that have completed
cardiacrehabilitation as recorded in the British Heart
FoundationNational Audit of Cardiac Rehabilitation (NACR)
• Compare the change in exercise capacity in the NACRcompared to
the Cochrane Review
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MethodsInclusion Criteria
• Date of Initiating event 1st April 2013 to 31st January
2017
• Primary diagnosis HF
• Valid pre and post CR assessment data
Exclusion Criteria
• No cardiovascular treatment listed during the ‘event’ (PCI,
CABG)
Statistics
• ANCOVA or logistic regression to compare pre and post
rehabilitation
Covariates
Age, sex, employment status, baseline NYHA, baseline weight,
ethnicity, marital
status, performance of rehabilitation centre
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Primary Diagnosis HF
N=16,728
Initiating Event Date
(01/04/2013 to 31/01/ 2017)
N=11,345
Started Rehabilitation
N= 6,344
Completed Rehabilitation
N= 4,756
Dataset
N=612,912100%
2.7%
1.9%
1.0%
0.8%
100%
55.9%
41.9%
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Baseline Demographics
N Baseline
Mean age (years) (Min & Max) 4756 69.5 (18-100)
Sex N(%) Male 3994 2728 (68)
NYHA (%) I/II/III/IV) 732 14, 50, 29, 7
BMI N(%) (overweight & obese) 1860 1354 (73)
Ethnicity N(%) (White) 3018 2742 (91)
Marital Status N(%) (Partner) 2522 1881 (75)
Employment N(%) (Retired) 2156 1449 (67)
Smoker N(%) (Former) 2574 1371 (53)
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Metabolic & Exercise capacity
N Pre CR Post CR Change
BMI (kg/m2) 1860 29.2 (7) 29.3 (6)* +0.1
Waist circumference (cm) 943 101.5 (15) 100.9 (15)* -0.6
Systolic BP (mmHg) 1942 124 (20) 124 (20)* +0.2
Diastolic BP(mmHg) 1943 72 (12) 71 (11)* -0.8
Total Cholesterol (mmol/L) 322 4.4 (1) 4.2 (1)* -0.2
HDL Cholesterol (mmol/L) 189 1.2 (1) 1.2 (0.4)* -0.04
LDL Cholesterol (mmol/L) 138 2.5 (1) 2.3 (1)* -0.2
Triglycerides (mmol/L) 151 1.6 (1) 1.6 (1)* -0.02
ISWT (m) 297 269 (142) 358 (169)* +89
6MWD (m) 636 262 (123) 313 (121)* +51
* P
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Questionnaires
28%
72%
Yes No
60%
40%
Yes No
PRE POST
N=1572 N=1573
30 mins exercise 5x/week (N=1536)
0
10
20
30
40
50
60
70
80
Normal Clinically Anxious/ DepressedP
erc
en
tage
Anxiety Depression
HADS Anxiety & Depression
1 2 1 2 1 2 1 2
1- Pre CR, 2- Post CR
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Study limitation
• Only those with exit assessment data on
NACR were included
• Some outcome measures poorly recorded
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ConclusionExercise capacity
Mood state
Cardio-metabolic and anthropometric
National improvements in exercise capacity
similar to Cochrane Review
Large number of patients not having a full assessment before and
after
cardiac rehabilitation
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Acknowledgements
NACR, University of York:
Prof. Patrick Doherty
Alexander Harrison
Supervisory team
Prof. Sally Singh (CERS)
Dr. Lauren Sherar (NCSEM)
Dr. Rachael Evans (CERS)
Dr. Dale Esliger (NCSEM)
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[email protected]
BACPR Annual Conference, 6th October 2017
