Improving prevention and care in heart disease with a data-driven health systems approach

Dr Dion Candelaria, University of Sydney

Postdoctoral Fellowship

Years funded: 2025 - 2026

Strengthening cardiac rehabilitation through data-driven improvement

My research will benefit over 56,700 Australians who experience a heart attack annually. Data shows about 1 in 5 will experience another attack or die within 3 years and cardiac rehabilitation is proven to reduce recurrent risk (by 18% at 1-year). However, low patient uptake persists. Only 30% of eligible patients attend and even fewer complete their program. Program availability and quality is also highly variable, so my research will address the need to improve cardiac rehabilitation quality through data-driven health systems improvement.

Building on the QUICR trial with implementation science

Randomised clinical trials (RCTs) are gold standard for evaluating the effectiveness of health interventions. However, RCTs focus mainly on whether an intervention works or not. Process evaluation provides a more complete picture of how interventions are delivered and received, and how context influences results. For this fellowship, I will build on and expand the Australian government-funded study, the QUality Improvement in Cardiac Rehabilitation (QUICR) trial that I am currently leading.

Over and beyond the QUICR trial aims, my research will:

1. identify what makes it easier or harder for cardiac rehabilitation staff to use and keep using local data and work with other programs to improve their own, and

2. determine whether better patient outcomes are achieved from programs that are highly engaged with the data-driven approach compared to those not as engaged.

Advancing health system redesign for better outcomes

I will achieve these aims by 1) using various data sources to evaluate the implementation and sustainability of the data-driven approach to improvement, and 2) analysing patient-level data to determine how the level of engagement of programs in the data-driven approach impacts patient outcomes.

This fellowship will expand my skills in implementation science to be an expert in understanding how to improve health systems through data. I will build leadership in examining how multi-site RCTs are robustly evaluated and sustained. My ultimate goal is to modernise cardiac rehabilitation programs through health system re-design, so more Australians with heart disease attend and complete rehabilitation, reduce ongoing cardiovascular risk, and maximise health outcomes.