Prevention Fails When Access Fails: A Reflection from the Great Prevention Pivot
At the Health Services Daily - Great Prevention Pivot Conference in Canberra on 16 and 17 June, Cardihab CEO Helen Souris made the case that Australia's cardiac rehabilitation access gap is not a clinical failure. It is an operational and funding failure. Here is what she said, and what it means for the 80% of people who are still missing out.
The conference
The Great Prevention Pivot brought together clinicians, policy makers, researchers, health system leaders and industry to ask a genuinely uncomfortable question: if we know what prevents chronic disease, why is the system still failing to deliver it?
Helen was invited to present under the title Prevention Fails When Access Fails. The framing was deliberate. Australia does not have a prevention knowledge problem. We have a prevention delivery problem. The evidence for what works has existed for decades. The gap is in making that evidence accessible to the people who need it.
The numbers that drove the conversation
The presentation opened with the statistic that sits at the centre of everything Cardihab does.
80% of Australians hospitalised with a cardiac diagnosis each year never access cardiac rehabilitation. That is 454,400 people, every year, missing out on a treatment that reduces cardiovascular mortality by 26%, cuts hospital readmissions by 18%, and is backed by decades of clinical evidence.
"We are spending $9.2 billion on cardiac disease hospital services, leaving est 454,000 eligible patients without post event cardiac rehab each year and resulting in c. 828,000 readmission bed days – each year."
The estimated cost of the CR access gap in avoidable readmissions alone is $2.2 billion annually.
The denominator is not invisible. We know how many people are admitted to hospital with a cardiac diagnosis. We know they should all receive cardiac rehabilitation post discharge. The gap is not hidden. It is a situation the system is perpetuating by default.
Why people are missing out
The presentation identified seven reinforcing barriers to cardiac rehabilitation access, each of which makes the others worse.
There is no structured referral trigger at hospital discharge. Patients are invisible between primary, secondary and tertiary care sectors: they leave the hospital system and fall into the gap before reaching primary care or community services. Conventional models assume patients can repeatedly attend clinic-based sessions during business hours, with transport, flexibility, and proximity to services. For most Australians, none of those assumptions hold.
Allied health is maldistributed. Rural and small towns have 36% of the allied health workforce per 1,000 people compared to major cities. 82% of health profession occupations are in national shortage. The workforce required to deliver conventional cardiac rehabilitation at scale simply does not exist.
On top of this, MBS funding rewards acute intervention over prevention. Digital health tools with strong regulatory and clinical credentials are still not adequately reimbursed.
Funding shapes what gets built and what gets used. Until digital therapeutics are funded, they will remain underutilised.
The evidence for a different way
The good news, and Helen was clear about this, is that we do not need to invent anything new. The solutions that can solve this problem are known and commercially available.
Independent research published in the European Heart Journal by the Baker Heart and Diabetes Institute evaluated Cardihab's digital cardiac rehabilitation program and found it improved survival +1.434 quality-adjusted life years per patient compared to usual care, at a cost of $14,302 per QALY. That is well below accepted cost-effectiveness thresholds. In 87% of 10,000 simulations, the program outperformed usual care on value.
Another publication from this independent evaluation showed 59% uptake and 91% completion Hospital readmission bed day reductions of 71% in the first 30 and 90 days post-discharge.
Cardihab is Australia's first and only TGA-registered digital therapeutic for cardiac rehabilitation. It has been operating for over 10 years, supporting thousands of patients across every state and territory, in partnership with public health services, private hospitals, private health insurers, and primary care providers.
The prevention pivot for cardiac rehab is not about new inventions
The session closed with a call that felt more urgent for being grounded in evidence rather than ambition.
The technology exists. The clinical validation exists. The regulatory framework exists. The blocker is institutional inertia, exacerbated by a funding architecture that has not kept pace with what the evidence supports.
Prevention that cannot be accessed is not prevention. For cardiac rehabilitation, the prevention pivot means structured referral to evidence-based programs at the point of discharge, funded and reimbursed as a standard component of cardiac care, not as a discretionary add-on.
"We do not discharge cardiac patients without medication because the evidence is clear. We should be asking why we discharge patients without structured referral to their choice of rehabilitation programs proven to reduce their risk of coming back."
We know what works. We know who it is failing. We know what it costs to do nothing.
It is time to fund the implementation.
Watch a recording of the presentation here: https://www.healthservicesdaily.com.au/the-great-prevention-pivot-summit-videos