Cardiac Rehabilitation Availability and Density around the Globe

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality globally.
• Cardiac rehabilitation (CR) significantly improves outcomes for patients with CVD.
• Current CR availability and capacity are not well-quantified globally.

Purpose of the Study:

• To ascertain the global availability, volume, and density of CR programs.
• To identify factors driving CR program volumes.
• To assess the gap between CR capacity and patient need.

Main Methods:

• A global survey of CR programs was conducted.
• Data were collected from 1082 programs across 93 countries.
• Generalized linear mixed models were used to assess factors associated with CR volumes.

Main Results:

• CR is available in 54.7% of countries, with significant regional disparities (Europe 80.7% vs. Africa 17.0%).
• Global CR capacity (1.65 million patients/year) is substantially lower than the estimated incidence of ischemic heart disease (IHD) (20.3 million cases/year).
• Systematic patient referral and alternative CR models increased volumes, while private or public funding decreased volumes compared to hybrid models.

Conclusions:

• CR is accessible in only about half of the world's countries.
• Where available, CR capacity is grossly insufficient to meet the demand from IHD patients.
• The majority of patients who could benefit from CR will not have access to it.