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Cardiac rehab use on the slide

The UK is moving backwards on cardiac rehabilitation with the proportion of patients attending schemes falling in the past few years, a new analysis reveals.

Fewer than one-third of eligible patients are now enrolled and the proportion has dropped since introduction of national guidance that was supposed to promote its use.

The national service framework for coronary heart disease was published in March 2000, setting a target of 85 per cent of patients to be enrolled in rehabilitation programmes after a myocardial infarction or revascularisation.

But researchers found the NSF had failed to prevent a decline in use after assessing its impact across the UK. The proportion enrolled rose from 25 per cent in 1998 to 31.5 per cent in 1999, but has since fallen from 31.3 per cent in 2003 to 28.5 per cent in 2004.

Study leader Dr Hugh Bethell, director of research at Basingstoke and Alton Cardiac Rehabilitation Centre, said: 'It's happening because they are not spending enough money on it. By the time it became respectable, around 2000, it was already up and running in nearly every trust in the country but in a low grade way and at no stage has funding been allocated.'

He added: 'This isn't going to get any better. In practice-based commissioning there's no tariff for cardiac rehabilitation; it's hidden inside the costs for episodes of care.'Dr Bethell said doctors could lobby their PCT to make sure programmes got funding, and that GPs should talk to their cardiologist colleagues.

Dr John Pittard, board member of the Primary Care Cardiovascular Society and a GP in Staines, Middlesex, said: 'You feel that with all of the health service bodies being cash-strapped, there's been a run- down of emphasis on this.

'Cardiac rehabilitation is meant to be done within six months of infarction. With any programme, if the stick gets a lot weaker or the carrot gets a little smaller, things drift.'

Dr Pravin Shah, CHD lead for South Stoke PCT, said there needed to be better dialogue between PCTs, GPs and specialists.The study, published online by the Journal of Public Health, looked at the numbers of eligible patients enrolled in cardiac rehabilitation across the UK from 1998 to 2004.

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