Cardiac rehabilitation: making a business case based on the evidence

Background: Cardiovascular disease and its management, are associated with a sizeable burden, on the NHS and UK economy each year. In addition to reducing mortality and improving quality of life, cardiac rehabilitation is effective at reducing unplanned readmissions. Purpose: This study was undertaken to ascertain if the national Department of Health cardiac rehabilitation (CR) cost model, promoting the benefits achieved through reduced unplanned readmissions, could be replicated in a real NHS setting using local data. Methodology: Patient data were retrospectively analysed for 30-day unplanned readmissions within specific cardiac diagnosis and treatment codes. National audit data were reviewed to ascertain local uptake of CR, and local databases used to ascertain the individual cost of providing CR, as well as the cost per unplanned readmission. The CR readmission costs were applied in the context of NHS England's ambition of 65% and 33% uptake in conventional cardiac patients and those with heart failure respectively. Results: The Department of Health model applied in the local context to conventional CR patients shows a potential saving; after taking into consideration the cost of delivering a CR programme to conventional cardiac patients at 65% uptake, this would lead to a saving of over £26 000. The equivalent model applied to 33% of eligible heart failure patients yields a potential benefit of over £19 000. Conclusion: A cost-saving readmissions approach, based on the Department of Health model, has been applied locally and could, if implemented, yield significant savings if CR programme uptake was delivered at the recommended levels.