Abstract
Background
Peripheral artery disease (PAD) is associated with impaired mobility and an increased risk of future cardiovascular events. Supervised exercise therapy is strongly recommended for patients with PAD; however, less than half of the vascular services worldwide have access to exercise programs. Conversely, cardiac rehabilitation programs are widely accessible, and could potentially facilitate access to exercise therapy for patients with PAD. This study aimed to survey cardiac rehabilitation coordinators in Australia to identify the number and characteristics of programs that accept patients with PAD, and perceived barriers and facilitators to the inclusion of patients with PAD in cardiac rehabilitation.
Methods
This was a cross-sectional survey study. The coordinators of Australian cardiac rehabilitation programs were contacted and invited to complete the survey that included questions about program characteristics, patient eligibility criteria, referral rates, patient assessments, exercise training designs, and perceived barriers and facilitators to the inclusion of patients with PAD in cardiac rehabilitation.
Results
One-hundred and nine cardiac rehabilitation programs responded to the survey. More than half of the programs (n=65/109, 60%) accepted PAD referrals. However, across all programs, PAD patients accounted for only 1.8% of all annual referrals. Very few programs that accepted patients with PAD reported conducting PAD-specific assessments (2%–5%) or prescribing PAD-specific exercises (12%). The main barriers to the inclusion of patients with PAD were lack of referrals (59%), service capacity (48%), and limited staff (48%). The main facilitators were listing PAD as an inclusion criterion (73%), receiving additional funding (71%), and educating cardiac rehabilitation staff on PAD care (68%).
Conclusions
While patients with PAD were often accepted into Australian cardiac rehabilitation programs, referral rates were very low. There is a need for stronger collaborations between cardiac rehabilitation programs and vascular services to establish direct referral pathways for patients with PAD. Such collaborations would support sharing of resources, opportunities for staff training and improved care for patients with PAD.