Hansard

I thank Helen Eadie for securing this debate on an extremely important issue.

As vice-convener of the cross-party group on heart disease and stroke, I too have had the privilege, on many occasions, of hearing about the substantial benefits that arise from provision of cardiac rehabilitation for all heart patients. Following open heart surgery in 2006, I also have personal experience of how effective cardiac rehab can be.

Last year, the group heard a presentation from the British Association for Cardiovascular Prevention and Rehabilitation on the new standards on which Helen Eadie’s motion focuses. Those standards include the goal of

“Ensuring referral of all eligible patients by cardiologists and/or specialist cardiovascular health care physicians to a prevention and rehabilitation programme as a standard (not optional) policy that is held in the same regard as the prescribing of cardioprotective medications.”

That is a worthy aspiration towards which we should all be working.

The evidence base for the effectiveness of cardiac rehab is overwhelming, as Helen Eadie said. It is highly cost effective—especially compared with surgical interventions for cardiac conditions—and it reduces premature mortality and hospital readmissions.

The Scottish intercollegiate guidelines network guidelines of 2002 said that cardiac rehab should be provided for all heart attack and bypass patients, and that all patients with heart failure and stable angina with limiting symptoms should be assessed for it. Those were grade A recommendations, which is the highest category of recommendation. In addition, the Government’s 2009 “Better Heart Disease and Stroke Care Action Plan” reiterated that health boards should recognise the importance of providing rehab to all heart patients.

As a result of that focus, NHS Scotland has over the past few years made good progress in improving provision of cardiac rehab, especially for people with acute heart conditions. The figures show that, nationally, 75 per cent of heart attack patients and 68 per cent of heart bypass patients were referred for cardiac rehab.

However, some health board areas still appear to be underperforming in provision of cardiac rehab. In the NHS Highland area, for example, just over 40 per cent of eligible heart attack patients were referred for cardiac rehab. It is clear that providing such services over a large rural area is a challenge, but that figure shows that there is still some way to go.

As is noted in the motion, there are particular issues to do with the provision of rehab for people with longer-term conditions—especially those with heart failure and angina—right across Scotland. In the NHS Highland area, for example, only 3 per cent of eligible heart failure patients appear to have been referred for rehab in 2011 and, nationally, the proportion of referrals of such patients is no better.

The British Heart Foundation Scotland and Chest, Heart and Stroke Scotland, which have led the campaigning work in this area over the past few years, now say that they believe that the time is right for the Scottish Government to consider what further steps it can take to drive improvements. I agree. Specifically, they feel that ministers should consider whether assessment for cardiac rehab would be a suitable candidate for a new HEAT target, as Helen Eadie said.

I am aware that ministers share the aspiration of the BACPR, the BHFS and CHSS that referral to cardiac rehab should be mandatory for all heart patients, as is the case for many pharmaceutical treatments for cardiac disease. Therefore, I would be interested to hear whether the minister believes that a HEAT target on referrals to cardiac rehab, which the charities are proposing, is something that his officials could examine.

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