Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 16;12(2):e054558.
doi: 10.1136/bmjopen-2021-054558.

Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol

Alline Beleigoli  1 , Stephen J Nicholls  2 , Alex Brown  3 , Derek P Chew  4 , John Beltrame  5   6 , Anthony Maeder  7 , Carol Maher  8 , Vincent L Versace  9 , Jeroen M Hendriks  10 , Philip Tideman  4   11 , Billingsley Kaambwa  4 , Christopher Zeitz  6 , Ivanka J Prichard  10 , Rosanna Tavella  5   6 , Rosy Tirimacco  11 , Wendy Keech  12 , Carolyn Astley  10 , Kay Govin  10 , Katie Nesbitt  10 , Huiyun Du  10 , Stephanie Champion  10 , Maria Alejandra Pinero de Plaza  10 , Imelda Lynch  13 , Vanessa Poulsen  13 , Marie Ludlow  13 , Ken Wanguhu  14 , Hendrika Meyer  15 , Ali Krollig  15 , Lemlem Gebremichael  10 , Chloe Green  10 , Robyn A Clark  10 ; CHAP Project Team
Affiliations

Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol

Alline Beleigoli et al. BMJ Open. .

Abstract

Introduction: Despite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%-50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants.

Methods and analysis: CHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation.

Ethics and dissemination: This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request.

Trial registration number: ACTRN12621000222842.

Keywords: cardiology; preventive medicine; telemedicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Using the model for large-scale knowledge translation to develop Country Heart Attack Prevention (CHAP). CR, cardiac rehabilitation.
Figure 2
Figure 2
Addressing the barriers through the Country Heart Attack Prevention (CHAP) model of care (exposure) according to the fourth stage of the model for large-scale knowledge translation (‘Engage, Educate, Execute, Evaluate’). CATCH, Country Access to Cardiac Health; CR, cardiac rehabilitation; GP, general practitioner.
See this image and copyright information in PMC

References

    1. World Health Organization . Cardiovascular diseases - WHO, 2021. Available: https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1 [Accessed 19/05/2021].
    1. Australian Bureau of Statistics . Causes of death ABS cat no 33030, 2020. Available: https://www.abs.gov.au/statistics/health/causes-death/causes-death-austr...
    1. Australian Institute of Health & Welfare (AIHW) . Heart attack, stroke and cardiac arrest symptoms, 2018. Available: https://www.heart.org/en/about-us/heart-attack-and-stroke-symptoms
    1. Clark RA, Coffee N, Turner D, et al. . Application of geographic modeling techniques to quantify spatial access to health services before and after an acute cardiac event: the cardiac accessibility and remoteness index for Australia (ARIA) project. Circulation 2012;125:2006–14. 10.1161/CIRCULATIONAHA.111.083394 - DOI - PubMed
    1. Australia NHFo . Interactive Australian heart maps. compare heart health indicators across Australia, 2021. Available: https://www.heartfoundation.org.au/health-professional-tools/interactive... [Accessed 16 Jun 2021].

Publication types