1. National Audit of Cardiac Rehabilitation: The Wales Perspective Juliet Tobler National Audit of Cardiac Services 18 th November 2015

2. Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation (2012) Core Components: Lifestyle risk factor management Psychological Health Cardio-protective Therapies Medical Risk Factor Management Health Behaviour Change and Education Long-term Management Audit and Evaluation 7 Standards: Evidence-based MDT Eligible groups Timely assessment Goal-driven NACR Business case

3. National Audit of Cardiac Rehabilitation – for England, Wales and Northern Ireland Report produced annually for the last 10 years Funded by the British Heart Foundation Produced by York University & HSCIC

4. Welsh Recorded Events = 7773 Welsh Cardiac Rehab = 2961 or 38%

5. What have been the problems? Data is only a good as what is inputted The number of patients we see is compared against the PEDW data What constitutes ‘Cardiac Rehabilitation’ as inputted on NACR Who should have Cardiac Rehabilitation that is counted on NACR Numbers are not enough – what are the outcomes

6. BACPR/NACR Certification of Cardiac Rehabilitation Programmes 2015 ‘The BACPR Standards and Core components are the gold standard for delivery of CR within the UK. However, from reading the NACR annual report, we realised that we would need to set the minimum standards at an achievable level that CR programmes could aim to meet whilst still delivering a good standard of CR service. So, for the majority of targets, we have used the national average taken from the latest published version of the NACR annual report’

7. What are the All Wales Cardiac Rehab Group doing to improve audit? Lots of meetings/teleconferences to discuss ambiguities, variances in interpretation, data entry issues Open communication with BHF and York University to identify problems and implement solutions Work within teams/services to improvement in the quality of NACR data submission Increase confidence in NACR data for Wales

8. How are things improving? NACR data inputting is now web-based which has improved and simplified the process The Cardiac Rehabilitation Teams across Wales are standardising their data inputting The NACR Annual Report – due December 2015 will change to focus more on outcomes rather than numbers

9. Outcomes for Cardiac Rehab Waiting times for starting CR Length of CR Programme Assessment before and after Cardiac Rehab of: Blood Pressure Cholesterol BMI/Weight Smoking Exercise Anxiety/Depression

10. What concerns the All Wales CR Group? NACR no longer mandated by the Welsh Government in the ‘National Clinical Audit & Outcome Review Plan 2015-16’ Welsh Government have identified Cardiac Rehabilitation as Heart Disease Delivery Plan Implementation Group ‘Priority’ for 2016/17

11. What next? Watch this space to see if changes in data inputting have improved Annual Report outcomes – due December 2015 Future reports – more local information so individual Cardiac Rehab Services can be compared!