Dudley Strategy for Tackling Health Inequalities 2010-15

Cardiac RehabilitationDudley has a gold star cardiac exercise rehabilitation service providing a 26 weekstructured exercise programme at phase 3 followed by a further 26 weeksmaintenance programme at phase 4. All patients are offered cardiac exerciserehabilitation post MI, and post MI revascularization, PCI, PPCI and CABG, and forstable and unstable angina. Table 2 shows uptakes across the conditions werevariable for 2008/9 in Dudley reflecting the national picture.Table 2CardiacRehabilitationUptake Rates(2008/9)TotalpatientsdischargedwithprimarydiagnosisEstimated No ofpatientseligible/referredfor cardiac rehab*Numberstartingcardiacrehab% of thoseeligiblestartingcardiacrehabAcute MI 362 304 131 43.1%CoronaryrevascularisationCABG/PCI388 326 156 47.8%ACS unstable 147 124 30 24.2%anginaStable Angina 145 122 42 34.4%PPCI 114 95 68 71.6%Other (HF, 144 121 52 42.9%arrhythmias)*This data was not routinely available for 08/09, hence this is an estimation based onthe Black Country Cardiac Network uptake of cardiac rehabilitation study whichidentified an 84% uptake rate for Action Heart. This data will be routinely availablefrom 09/10.An uptake study was conducted across the Black Country during 2008/9 whichidentified that 16% of patients were not referred for Cardiac Rehabilitation in Dudleyand showed significant differences in referral by age, diagnostic group, ethnicity,gender and employment status. The audit was repeated during 09/10 with largernumbers so that a more detailed analysis could be carried out at each healtheconomy level but this is not yet available.ConclusionsThe general conclusions from this acute CHD Health Needs Assessment are:The admissions data for CVD and AMI shows that at the macro level, admissionsgenerally reflect the higher risk and needs of specific population groups includingmen, BME and deprived groups but that other factors other than actual need,strongly influence access to treatment once deprivation, sex and age areaccounted for.Public knowledge and awareness of the symptoms and need to call 999 is low inthe general population and pre hospital delays are greater in older people,women and patients with pre-existing conditions. There are also health seekingbehaviour differences for ethnic and deprived groups82