title: Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey.
abstract: BACKGROUND
  Participation of patients with heart failure in cardiac rehabilitation in the UK is low. This study investigated the availability of cardiac rehabilitation services for patients with heart failure in the UK and the views of service coordinators on ideal service models.
  
  
  METHODS
  Our study was a cross-sectional national postal survey that was mailed to 342 service coordinators in the UK between April and June 2009.
  
  
  METHODS
  We developed a 38-item questionnaire to survey all cardiac rehabilitation service coordinators on the National Audit of Cardiac Rehabilitation register in the UK in 2009.
  
  
  RESULTS
  The survey response rate was 71% (244/342). Forty three per cent (105/244) of coordinators did not accept patients with heart failure to their cardiac rehabilitation services. Most coordinators who did accept patients with heart failure offered their services to patients with a variety of cardiac conditions, though referral criteria and models of care varied widely. Services inconsistently used New York Heart Association classes and left ventricular ejection fraction measures to select patients. Few offered separate dedicated heart failure programmes (14%; 33/244) but where these existed they ran for longer than programmes which included patients with heart failure alongside other cardiac patients (10.9 vs 8.5 weeks; F = 4.04; p = 0.019). Few offered home-based options for patients with heart failure (11%; 27/244). Coordinators accepting patients with heart failure to their cardiac rehabilitation services tended to agree that patients with heart failure should be included in services alongside other cardiac patients (χ(2) = 6.2; p = 0.013).
  
  
  CONCLUSIONS
  There is limited access for patients with heart failure to cardiac rehabilitation in the UK. Local policies on referral and selection criteria differ and reflect coordinators' views rather than clinical guidance.
authors.affiliation: National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, UK Guy's and St Thomas' NHS Foundation Trust, UK King's College London, Institute of Gerontology, UK amanda.buttery@kclalumni.net.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Buttery
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, UK.
authors.forename: Gerald
authors.initials: G
authors.lastname: Carr-White
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, UK King's College London, Institute of Gerontology, UK.
authors.forename: Finbarr C
authors.initials: FC
authors.lastname: Martin
authors.affiliation: King's College London, Institute of Gerontology, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Glaser
authors.affiliation: King's College London, Institute of Gerontology, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Lowton
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Heart; exercise; heart failure; patient care; physical activity; rehabilitation