Cardiac Rehabilitation and Secondary Prevention Roundtable: Australian Implementation and Research Priorities

Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disease burden globally [1]. CVD resulted in >1.1 million hospitalisations in 2015-16, and incurs the highest level of health care sector expenditure in Australia (11-12% of total health expenditure) [2]. CHD accounts for the greatest single disease morbidity (>500,000 bed-days annually) and nearly one fifth of all deaths with a total cost of $1.14 billion annually [2]. Over 65,000 Australians experience an acute coronary event (heart attack or unstable angina) each year [3], and, importantly, around a third of these occur in people who have prior CHD and are therefore largely preventable [4], [5]. However, Australian data from SNAPSHOT ACS demonstrates that only one-quarter of patients with acute coronary syndrome (ACS) receive optimal care (medicines, referral to cardiac rehabilitation and lifestyle advice) at hospital discharge [6]. Follow-up data of the same cohort has shown that almost 20% of patients admitted to hospital with ACS die within 3 years of discharge, and 40% experience another CVD hospitalisation [7]. With an ageing population, more people surviving initial ACS events, and burgeoning lifestyle-related health problems, the health burden of CVD is escalating globally [8]. Thus, improving post-discharge care through secondary prevention strategies (healthy living, adherence to medicines) is a current national and international priority [9], [10].