{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:46:05Z","timestamp":1762004765634,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2015,8,27]]},"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Cardiac rehabilitation (CR) is an evidence-based intervention delivered by a wide range of high-volume and low-volume centres; however, the extent of volume\u2013outcome relationship is yet to be studied. There is a lack of consensus about the effect of volume on outcomes, with evidence of mixed effects in acute and chronic care. The aim of this study is, to investigate the extent of association of outcomes in CR with patient volume.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data was validated and extracted from the national audit from 2012 to 2013 for each CR centre. Volume was calculated as the total number of patients entering outpatient CR. Hierarchical multiple regression models were used to test for relationships between volume and outcomes. The outcomes included body mass index, blood pressure, psychosocial well-being, cholesterol, smoking cessation and physical activity. The analyses were adjusted for centre and patient characteristics and confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The number of patients included in the volume analysis was 48\u2005476, derived from 178 CR centres. The average age per centre was 66\u2005years with a 70% male distribution of patients enrolled. Regression analysis revealed no volume\u2013outcome relationship, additionally no statistical significance existed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Unlike cardiac surgery this study, after accounting for staffing, age, gender and comorbidity, shows no effect of volume on outcome following CR delivered by high-volume and low-volume programmes. Based on our data there is no support for centralisation of services. Our findings and methodology can be used as a benchmark for future volume\u2013outcome relationship studies in CR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2015-000304","type":"journal-article","created":{"date-parts":[[2015,11,11]],"date-time":"2015-11-11T22:13:33Z","timestamp":1447280013000},"page":"e000304","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Observational study of the relationship between volume and outcomes using data from the National Audit of Cardiac Rehabilitation"],"prefix":"10.1136","volume":"2","author":[{"given":"Patrick","family":"Doherty","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander S","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Knapton","sequence":"additional","affiliation":[{"name":"British Heart Foundation, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Dale","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,11,11]]},"reference":[{"key":"2025081612314260000_2.1.e000304.1","doi-asserted-by":"crossref","unstructured":"Heran BS , Chen JM , Ebrahim S , et al . Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;(7):CD001800. doi:10.1002\/14651858.CD001800.pub2","DOI":"10.1002\/14651858.CD001800.pub2"},{"key":"2025081612314260000_2.1.e000304.2","unstructured":"NICE Clinical Guidelines 172\u2014secondary prevention in primary and secondary care for patients following myocardial infarction. http:\/\/www.nice.org.uk\/guidance\/cg172\/resources (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.3","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcm020"},{"key":"2025081612314260000_2.1.e000304.4","unstructured":"British Association for Cardiovascular Prevention and Rehabilitation. The BACPR standard and core components for cardiovascular disease prevention and rehabilitation. 2nd edn. 2012. http:\/\/www.bacpr.com\/resources\/46CBACPRStandardsandCoreComponent s 2012.pdf (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300302"},{"key":"2025081612314260000_2.1.e000304.6","unstructured":"The National Audit of Cardiac Rehabilitation (NACR). Annual Statistical Report . UK: NACR, 2014. http:\/\/www.cardiacrehabilitation.org.uk\/docs\/2014.pdf (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.7","unstructured":"Scottish Intercollegiate Guidelines Network (SIGN). Cardiac rehabilitation: a national guideline. http:\/\/www.sign.ac.uk\/pdf\/sign57.pdf (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.634436"},{"key":"2025081612314260000_2.1.e000304.9","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs448"},{"key":"2025081612314260000_2.1.e000304.10","unstructured":"Department of Health. Cardiovascular disease outcomes strategy. Improving outcomes for people with or at risk of cardiovascular disease. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachmentdata\/fi le\/217118\/9387-2900853-CVD-Outcomes web1.pdf (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.11","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-301728"},{"key":"2025081612314260000_2.1.e000304.12","doi-asserted-by":"crossref","unstructured":"Lee HS , Lin HC . Is the volume-outcome relationship sustained in psychiatric care? 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UK Physical Activity Guidelines. https:\/\/www.gov.uk\/government\/publications\/uk-physical-activity-guidelines (accessed 7 Aug 2015)."},{"key":"2025081612314260000_2.1.e000304.17","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312449597"},{"key":"2025081612314260000_2.1.e000304.18","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314540840"},{"key":"2025081612314260000_2.1.e000304.19","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.701466"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2015-000304","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T19:31:47Z","timestamp":1755372707000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2015-000304"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,11,11]]},"published-print":{"date-parts":[[2015,10]]}},"alternative-id":["10.1136\/openhrt-2015-000304"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2015-000304","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2015,10]]}}}