Cardiac Rehabilitation in Patients with Coronary Heart Disease-Challenges, Inequalities, and Opportunities for Global...

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Cardiac rehabilitation (CR) is a Class I recommended secondary prevention strategy for coronary heart disease.
• Despite proven benefits in reducing morbidity, mortality, and improving quality of life, CR is significantly underutilized globally.
• The INTERASPIRE study revealed a substantial gap between CR evidence and its implementation, marked by low referral and adherence rates.

Purpose of the Study:

• To highlight the global underutilization of cardiac rehabilitation (CR).
• To identify barriers and inequities in CR referral and adherence.
• To underscore the need for improved CR implementation and access.

Main Methods:

• Analysis of global CR referral and adherence data, as exemplified by the INTERASPIRE study.
• Examination of systemic factors contributing to the evidence-implementation gap.
• Review of existing literature on CR benefits and barriers.

Main Results:

• Cardiac rehabilitation (CR) programs are strikingly underutilized worldwide, despite robust evidence supporting their efficacy.
• Significant inequities in CR access and utilization persist across different regions and socioeconomic groups.
• Systemic failures in translating guideline recommendations into practice were identified as key drivers of low CR implementation.

Conclusions:

• Addressing the global underutilization of CR requires significant investment in infrastructure and equitable referral strategies.
• Standardization of CR program content and exploration of innovative delivery models like telehealth are essential.
• Ensuring universal access to CR is a critical clinical imperative and a matter of health equity for cardiovascular disease patients.