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NICE: Better access to cardiac programmes needed

Better access to cardiac rehabilitation programmes could save more heart attack survivor's lives, the National Institute for Health and Care Excellence (NICE) has claimed. 

People who have had a heart attack (myocardial infarction, or MI) have a considerably increased risk of having another one. 

Updated guidance published by NICE states the best ways to reduce this risk is by improving the care of hundreds of thousands of adults in England and Wales who have survived a heart attack. 

Heart attacks are usually caused by a blockage in the coronary artery, a preventable complication of coronary heart disease (CHD). 

When compared internationally, the UK death rate from CHD is relatively high with more than 103,000 deaths per year. 

There are currently around 1 million men and nearly 500,000 women in the UK who have had a heart attack. 

A key focus of the updated guideline is on using cardiac rehabilitation programmes to help people recover. 

Dr Linda Speck, consultant clinical health psychologist and member of the Guideline Development Group said: “"This updated guideline addresses ways of improving uptake of cardiac rehabilitation programmes and the need to encourage early attendance.

“It also recognises the importance of exploring individuals' health beliefs and illness perceptions which may be significant barriers to attendance." 

The guideline recommends that cardiac rehabilitation programme should begin as soon as possible, and before the patient leaves hospital. 


Once they have gone home, they should be invited to a cardiac rehabilitation session which should start within 10 days of their discharge. 

Cardiac rehabilitation programmes should be offered in a choice of venues (including at the person's home, in hospital and in the community) and at a choice of times of day (for example, sessions outside of working hours). 

The programmes should provide a range of different types of exercise to meet the needs of people of all ages, or those who have other illnesses. 

Some people, such as those from black and minority ethnic groups, people from rural communities and people with mental and physical health conditions, may be less likely to access cardiac rehabilitation programmes. 

The guideline therefore recommends that programmes should be made equally accessible and relevant to all groups. 

Kathryn Carver, cardiac rehabilitation lead nurse and member of the Guideline Development Group, said: “The national average uptake for cardiac rehabilitation in 2012 was 46%. The recommendation that cardiac rehabilitation should be commenced prior to discharge from hospital with an early invitation to a comprehensive cardiac rehabilitation programme within 10 days of discharge will be challenging. 

“However the evidence is clear that uptake as well as completion and clinical outcomes are better if this can be achieved.”