Edinburgh Napier University

  Background: Currently there is a large evidence-practice gap in secondary prevention of coronary heart disease (CHD) where only the minority of people with CHD access facility cardiac rehabilitation (CR). this study compares attendance rates at secondary prevention programmes before and after implementation of a complementary novel telephone based CHOICE intervention. Barriers and enablers to implementing the novel model of secondary prevention among acute coronary syndrome (ACS) survivors were determined.

Methods: We collected data for two six-month periods and summarised the total number of ACS admissions (identified using diagnostic related codes) at four tertiary hospitals and determined the number and proportion of those patients who attended a secondary prevention program. In the first period (May-Nov 2008) only facility CR was available and in the second period (May-Nov 2009) facility CR and an additional novel telephone-based CHOICE program were available. We then compared the proportion of ACS patients admitted in each period who participated in CR or CHOICE. A literature review, qualitative surveys focus groups and interviews were used to elicit barriers and enablers to introducing and implementing the CHOICE programme.

Results: In the May-Nov 2008, period 821 patients were admitted with an ACS and 293 (36%) attended facility CR. For the corresponding period in 2009, 693 patients were admitted with ACS, an estimated one third participated in CR and 121 (17.5%) participated in the additional CHOICE program. Overall, 17.5% patients attended CHOICE who would not otherwise have received formal secondary prevention and this difference was significant (CI 0.12 to 0.21, p<0.001). A substantial number declined to participate in the CHOICE program because it was a research study (79 (10%), CI 0.06 to 0.16, p <0.001). Analysis of the barriers and enablers suggest that actively engaging patients, having informed and knowledgeable staff and a social context of support for evidence based clinical practice were important determinants for successful implementation.

Conclusions: Offering a complementary telephone intervention in addition to CR significantly improved participation in a formal secondary prevention programme. Improving access to an effective secondary prevention program for patients who have CHD is likely to translate into reductions in coronary events and absolute risk.