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Clinical Articles, News & Views

HEART UK reports on post-MI inequalities

HEART UK, the Cholesterol Charity, has called on all NHS Trusts to offer cardiac rehabilitation services to patients more vigorously, following the launch of a report1 highlighting the inequalities in treatment after myocardial infarction (MI) in England.

The cardiac rehabilitation report found that 2,100 patients across England are not being offered cardiac rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

HEART UK Chief Executive Jules Payne said: “It is encouraging that many patients are offered cardiac rehabilitation after they have had a heart attack but the variation in uptake across the country is unacceptable. Action is needed on both a national and local level to ensure that all patients are offered this service to help them to recover and return to normal life as soon as possible after their heart attack”.

“HEART UK is deeply concerned that in some areas of the country less than 40% of patients are undertaking cardiac rehabilitation so there is a huge educational job to be done as well. Patients have such an increased chance of recovery if they undertake the vital and tremendously valuable aftercare that hospitals should be providing to all.”

Although 95% of patients are offered cardiac rehabilitation after MI, the report uncovers regional variations in the percentage of patients who take up invitations to cardiac rehabilitation – ranging from just 36.7% in Mid Cheshire Hospitals NHS Foundation Trust to 99.8% in Royal Devon and Exeter NHS Foundation Trust.

Dr Henry Purcell, Senior Fellow in Cardiology, Royal Brompton Hospital, London, said: “Cardiac rehabilitation can accelerate recovery and reduce mortality by up to 25%, following an acute coronary syndrome (ACS). There is abundant evidence that many UK patients are not participating in these programmes and are not receiving optimal lifestyle and pharmacological interventions to prevent further cardiac events. The present report addresses these issues. It sets out a large number of recommendations, including the development of a quality standard on secondary prevention after an ACS. Hopefully this pragmatic report will be read and acted upon by all UK health care professionals”.

Other key findings in the report, which was collated by HEART UK and MHP Health Mandate, include:

  • There is limited evidence of hospitals  undertaking sufficient follow up activities to encourage participation in cardiac rehabilitation programmes
  • There is variation in the content of cardiac rehabilitation programmes and not all areas offer all four phases of cardiac rehabilitation which are recommended by the National Institute for Health and Clinical Excellence (NICE)
  • Cardiovascular disease will need to contribute around £1.54 billion savings in order for the NHS to meet the Nicholson challenge, which aims to find £20 billion in efficiency savings by 2015 yet there are examples of providers offering expensive cardiac rehabilitation services that do not lead to better outcomes for patients
  • Twenty five NHS hospital trusts  have selected measures relevant to cardiac rehabilitation in their commissioning priorities; this prioritisation should be translated into clear action on ensuring high quality services for patients
  • The report makes 20 recommendations about how to improve participation in cardiac rehabilitation and capitalise on the NHS reforms to improve outcomes for patients who have had a heart attack

The most recent data from 2008 show that 191,000 people died from heart and circulatory diseases, including 88,000 deaths attributed to coronary heart disease (CHD). Of these, 50,000 people died prematurely (under the age of 75) as a result of cardiovascular disease, accounting for more than one in four deaths in men and one in five deaths in women.


1 After the event: getting care right for patients after a heart attack: getting care right for patients after a heart attack. HEART UK, 2012.  Available from:

Published on: February 7, 2012

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