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; Stephen J Nicholls; Alex Brown; Derek P Chew; John Beltrame; Anthony Maeder; Carol Maher; Vincent L Versace; Jeroen M Hendriks; Philip Tideman; Billingsley Kaambwa; Christopher Zeitz; Ivanka J Prichard; Rosanna Tavella; Rosy Tirimacco; Wendy Keech; Carolyn Astley; Kay Govin; Katie Nesbitt; Huiyun Du; Stephanie Champion; Maria Alejandra Pinero de Plaza; Imelda Lynch; Vanessa Poulsen; Marie Ludlow; Ken Wanguhu; Hendrika Meyer; Ali Krollig; Lemlem Gebremichael; Chloe Green; Robyn A Clark; CHAP Project Team

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

BMJ Open. 2022 Feb 16;12(2):e054558. doi: 10.1136/bmjopen-2021-054558.

Authors

Alline Beleigoli¹, Stephen J Nicholls², Alex Brown³, Derek P Chew⁴, John Beltrame^{5

6}, Anthony Maeder⁷, Carol Maher⁸, Vincent L Versace⁹, Jeroen M Hendriks¹⁰, Philip Tideman^{4

11}, Billingsley Kaambwa⁴, Christopher Zeitz⁶, Ivanka J Prichard¹⁰, Rosanna Tavella^{5

6}, Rosy Tirimacco¹¹, Wendy Keech¹², Carolyn Astley¹⁰, Kay Govin¹⁰, Katie Nesbitt¹⁰, Huiyun Du¹⁰, Stephanie Champion¹⁰, Maria Alejandra Pinero de Plaza¹⁰, Imelda Lynch¹³, Vanessa Poulsen¹³, Marie Ludlow¹³, Ken Wanguhu¹⁴, Hendrika Meyer¹⁵, Ali Krollig¹⁵, Lemlem Gebremichael¹⁰, Chloe Green¹⁰, Robyn A Clark¹⁰; CHAP Project Team

Affiliations

¹ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia alline.beleigoli@flinders.edu.au.
² Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.
³ Indigenous Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
⁴ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁵ The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁶ Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁷ Flinders Digital Health Research Centre, Flinders University, Adelaide, South Australia, Australia.
⁸ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia.
⁹ Deakin Rural Health, School of Medicine, Deakin University, Melbourne, Victoria, Australia.
¹⁰ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
¹¹ Integrated Cardiovascular Clinical Network, Rural Support Service, Adelaide, South Australia, Australia.
¹² Health Translation SA, Adelaide, South Australia, Australia.
¹³ National Heart Foundation of Australia, Mawson, Australia Central Territory, Australia.
¹⁴ Royal Australian College of General Practitioners, Waikerie, Victoria, Australia.
¹⁵ Rural Support Service, SA Health, Adelaide, South Australia, Australia.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia
Cardiac Rehabilitation* / methods
Cardiovascular Diseases*
Humans
Myocardial Infarction*
National Health Programs
Prospective Studies