Implementation of Evidence-Based, Person-Centered Alternative Delivery Models for Cardiac Rehabilitation in a Rural and Remote Population: The Country Heart Attack Prevention (CHAP) Project - 02/09/26

Doi : 10.1016/j.hlc.2026.02.008

Alline Beleigoli, MD, PhD ^a,^b, Maria Alejandra Pinero de Plaza, PhD ^a, Lemlem G. Gebremichael, PhD ^a, Norma Bulamu, PhD ^b, Aarti Guyliani, MSc ^a, Derek P. Chew, MBBS, PhD ^b, Stephen J. Nicholls, MBBS, PhD ^c,^d, Joyce S. Ramos, PhD ^a, Carol Maher, PhD ^e, John Beltrame, MBBS, PhD ^f,^g,^h, Billingsley Kaambwa, PhD ^b, Vincent L. Versace, PhD ⁱ, Jeroen M. Hendriks, PhD ^a,^g,^j, Rosanna Tavella, PhD ^f,^g,^h, Jonathon Foote, BN ^a, Katie Nesbitt, PhD ^a, Sarah Powell, BSc ^a, Wendy Keech, MPH ^k, Marie Ludlow, PhD ^l, Anthony Maeder, PhD ^m, Ken Wanguhu, MBBS ⁿ, Hendrika Meyer, MBBS ^o, Ivanka Prichard, PhD ^a, Orathai Suebkinorn, MSc ^a, Christopher Zeitz, MBBS ^f, Alex Brown, PhD ^p,^q, Robyn A. Clark, PhD ^a,^⁎
on behalf of the
NHMRC CHAP Project team

^a Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

^b Flinders Health and Medical Research Institute, College of Medicine and Public Health, Adelaide, SA, Australia

^c Victorian Heart Institute, Monash University, Melbourne, Vic, Australia

^d Victorian Heart Hospital (VHH) and MonashHeart, Melbourne, Vic, Australia

^e Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

^f Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia

^g Central Adelaide Local Health Network, Adelaide, SA, Australia

^h Basil Hetzel Institute for Translational Research, Adelaide, SA, Australia

ⁱ Deakin Rural Health, School of Medicine, Deakin University, Melbourne, Vic, Australia

^j Maastricht University (UM), and the Care and Public Health Research Institute (CAPHRI), Maastricht, Nederlands

^k Health Translation SA, Adelaide, SA, Australia

^l National Heart Foundation of Australia, Melbourne, Vic, Australia

^m Flinders Digital Health Research Centre, Flinders University, Adelaide, SA, Australia

ⁿ Royal Australian College of General Practitioners, Adelaide, SA, Australia

^o Yorke and Northern Local Health Network, SA Health, SA, Australia

^p South Australian Health and Medical Research Institute Limited, Adelaide, SA, Australia

^q The Kids Research Institute Australia, Perth, WA, and The Australian National University, Canberra, ACT, Australia

^∗ Corresponding author at: Matthew Flinders Emeritus Professor and Flinders University Distinguished Alumni. Mail: GPO Box 2100 Adelaide, SA 5001, Australia Matthew Flinders Emeritus Professor and Flinders University Distinguished Alumni. Mail: GPO Box 2100 Adelaide SA 5001 Australia

Abstract

Background & Aims

Access and adherence to cardiac rehabilitation (CR) remain suboptimal, particularly in rural and remote settings. This study evaluated the implementation of person-centred, evidence-based CR delivery model tailored to improve access and completion.

Methods

The implementation framework utilised was the Model for Large-Scale Knowledge Translation. The Country Heart Attack Prevention (CHAP) project introduced evidence-based flexible CR including, face-to-face, telehealth, telephone, web-based and primary care options. A matched prospective cohort compared CR attendance, completion (primary outcomes), cardiovascular (CV) readmissions, mortality, and emergency department (ED) visits between CHAP rural services and standard metropolitan face-to-face CR.

Results

CR attendance was comparable between groups (24.2% vs 23.8%; odds ratio [OR] 1.15; 95% confidence interval [CI] 0.89–1.47; p=0.16), but completion rates were significantly higher in the CHAP Project (77.1% vs 57.5%; OR 1.69; 95% CI 1.30–2.18; p<0.001). Patient satisfaction was also greater (85.9% vs 77.1%; p<0.001). Median waiting times were similar (38 vs 36 days; p=0.008). Alternative delivery models were equivalent to traditional face-to-face modes for CV readmissions (hazard ratio [HR] 1.19; 95% CI 0.96–1.49; p=0.17), CV mortality (HR 1.70; 95% CI 0.92–3.16; p=0.09), and ED visits (HR 1.06; 95% CI 0.94–1.21; p=0.33). CR completion through CHAP was cheaper and more effective (costs: $6,542 vs $8,689; completions: 77.1% vs 57.5%). The CHAP model had over 50% probability of being cost-effective in improving CR completion. Uptake of the CHAP model would result in a cost reduction ranging from $2 million (m) at 20% uptake to $10m if all patients referred attended and completed CR.

Conclusions

The CHAP Project significantly improved program completion and achieved satisfaction without compromising clinical outcomes and showed important levels of economic benefit. Broader implementation of person-centred models of CR, across all geographic areas to enhance uptake and impact of CR in underserved populations is recommended.

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Keywords : Evidence-based, Implementation, Alternate models, Cardiac rehabilitation

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Vol 35 - N° 9

P. 1337-1347 - septembre 2026 Retour au numéro

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Implementation of Evidence-Based, Person-Centered Alternative Delivery Models for Cardiac Rehabilitation in a Rural and Remote Population: The Country Heart Attack Prevention (CHAP) Project - 02/09/26

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Background & Aims

Methods

Results

Conclusions

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