Cardiac Rehabilitation: Under-Utilized Globally

Area of Science:

• Cardiology
• Public Health
• Healthcare Management

Background:

• Cardiac rehabilitation (CR) programs are crucial for patient recovery but suffer from low utilization rates.
• Understanding the extent of under-utilization and its drivers is essential for improving cardiovascular care.
• Existing CR programs face capacity challenges, limiting access for eligible patients.

Purpose of the Study:

• To review the current status of cardiac rehabilitation utilization.
• To identify key reasons contributing to the under-utilization of CR.
• To summarize effective strategies for increasing the uptake and completion of CR.

Main Methods:

• Global audit of cardiac rehabilitation (CR) programs by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR).
• Analysis of the first randomized trial investigating automatic/systematic CR referral.
• Inclusion of updated evidence from the Cochrane review on interventions to boost CR use.

Main Results:

• The ICCPR audit established the number of additional CR program spots required globally.
• Automatic/systematic CR referral demonstrated a significant increase in patient completion rates.
• Clinician encouragement at the bedside emerged as a highly impactful intervention for CR utilization.
• Training courses for clinicians on promoting CR are now available.

Conclusions:

• Implementing automatic referral systems and bedside clinician encouragement can substantially improve CR utilization.
• Risk-based patient triage to varied program models can enhance capacity and adherence.
• Addressing under-utilization requires a multi-faceted approach involving systemic changes and direct patient engagement.