News release

From: Flinders University

Cardiac rehabilitation (CR) is strongly recommended after heart events and procedures, yet remains underused, with only 20–50% of eligible patients participating – despite well-established recovery benefits.

To address long-standing barriers to access and continuity of care, Flinders University researchers established and evaluated the Country Heart Attack Prevention (CHAP) model of care across 15 rural and remote cardiac rehabilitation services in South Australia.

CHAP provided evidence-based, person-centred rehabilitation through flexible delivery options including face-to-face, telehealth, telephone, web-based and primary care pathways.

“This research shows we can improve access for rural and remote communities without compromising clinical outcomes — and it delivers important economic benefit,” says Dr Maria Alejandra Piñero de Plaza from the Caring Futures Institute at Flinders University.

“When services are designed around real-world barriers, more people can complete rehabilitation and gain the full benefits.”

Key outcomes of the research showed:

• Improved CR completion: Attendance was similar between CHAP and usual care (24.2% versus 23.8%), but completion was higher in CHAP (77.1% versus 57.5%).
• No compromise in clinical outcomes: There were no significant differences in 12-month cardiovascular readmissions, cardiovascular mortality, or emergency department presentations between CHAP and usual care.
• Better patient experience: Patient satisfaction was higher in CHAP (85.9%) when compared with usual care (77.1%).
• Economic benefit: The cost of each completed cardiac rehabilitation program was lower in CHAP ($6,542) compared with usual care ($8,689). State-wide implementation is estimated to save about $2 million per year with 20% uptake by patients, increasing to about $10 million per year if all eligible patients attend and complete rehabilitation.

With these findings, the researchers recommend broader implementation of person-centred, flexible CR models across geographic areas to improve uptake and impact in underserved populations.

“Implementing this approach has already helped shape South Australia’s new state-wide model of care for cardiac rehabilitation,” says Dr Piñero de Plaza.

The CHAP research team was led by Distinguished Emeritus Professor Robyn Clark and Dr Alline Beleigoli.

Results of the CHAP evaluation – ‘Implementation of Evidence-Based, Person-Centred Alternative Delivery Models for Cardiac Rehabilitation in a Rural and Remote Population: The Country Heart Attack Prevention (CHAP) Project,’ by a team of 31 authors, including Flinders University’s Alline Beleigoli, Robyn Clark and Maria Alejandra Piñero de Plaza – have been published in Heart, Lung and Circulation journal. DOI: 10.1016/j.hlc.2026.02.008

Authors (in order): Alline Beleigoli; Maria Alejandra Piñero de Plaza; Lemlem G Gebremichael; Norma Bulamu; Aarti Guyliani; Derek P Chew; Stephen J Nicholls; Joyce S Ramos; Carol Maher; John Beltrame; Billingsley Kaambwa; Vincent L Versace; Jeroen M Hendriks; Rosanna Tavella; Jonathon Foote; Katie Nesbitt; Sarah Powell; Wendy Keech; Marie Ludlow; Anthony Maeder; Ken Wanguhu; Hendrika Meyer; Ivanka Prichard; Orathai Suebkinorn; Christopher Zeitz; Alex Brown; Robyn A Clark.