BACKGROUND: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. METHODS: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. FINDINGS: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). INTERPRETATION: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.

Asociacion Cardiovascular Centroccidental 17 Callejón 12 Barquisimeto 3001 Lara Venezuela

Beijing United Family Hospital 2 Jiangtai Rd Chaoyang Qu Beijing Shi 100096 China

Betsi Cadwaladr University Health Board Wrexham Maelor Hospital Croesnewydd Road Wrexham LL13 7TD Wales United Kingdom

Bispebjerg Frederiksberg Hospital Bispebjerg Bakke 23 2400 København NV Denmark

Cardiac Rehabilitation Research Centre Cardiovascular Research Institute Isfahan University of Medical Sciences Hezar Jerib Ave Isfahan 81746 73461 IR Iran

Cardiovascular Institute of Buenos Aires Av del Libertador 6302 1428 Buenos Aires Argentina

Cardiovascular Research Group Division of Cardiology Oulu University Hospital University of Oulu Finland

Central Hospital of Social Security Institute Asuncion Paraguay

Department of Physiotherapy Manipal College of Health Professions Manipal Academy of Higher Education Manipal 576104 Karnataka

Edinburgh Napier University 9 Sighthill Ct Edinburgh EH11 4BN Scotland United Kingdom

Fu Jen Catholic University Hospital and School of Medicine College of Medicine Fu Jen Catholic University No 69 Guizi Road Taishan District New Taipei City 24352 Taiwan

Gregorio Marañón General University Hospital Gregorio Marañón Health Research Institute Dr Esquerdo 46 28007 Madrid Spain

Heart House Martin Bagarova 30 Martin Podháj Slovakia

Hospital Raja Isteri Pengiran Anak Saleha Bandar Seri Begawan BA1710 Brunei

Hospital Santa Marta R de Santa Marta 50 Lisbon 1169 024 Portugal

ICCCV Instituto de Cardiología y Cirugía Cardiovascular No 702 entre A y Paseo Vedado Calle 17 La Habana Cuba

Institute for Cardiology and Sports Medicine Dep Preventive and Rehabilitative Sport Medicine and Exercise Physiology German Sport University Cologne Am Sportpark Müngersdorf 6 50933 Cologne Germany

Institute of Cardiology Str Testemitanu 20 Chisinau Republic of Moldova

Institute of Cardiovascular Diseases Clinical Center of Serbia Dr Koste Todorovića 8 11000 Beograd Serbia

Instituto Nacional Cardiovascular Jirón Coronel Zegarra Jesus Maria Lima 11 Peru

Instituto Nacional de Cardiología Belisario Domínguez Sección 16 Tlalpan 14080 CDMX Mexico

Istituti Clinici Scientifici Maugeri Care and Research Institute Department of Cardiac Rehabilitation Pavia Italy

Karolinska Institutet Department of Clinical Sciences Danderyd Hospital 182 88 Stockholm Sweden

Laboratory of Sports Medicine Aristotle University of Thessaloniki Thessaloniki 57001 Greece

Lithuanian University of Health Sciences A Mickevičiaus g 9 Kaunas 44307 Lithuania

Loire Vendée Océan Hospital Boulevard des Régents 44270 Machecoul France

Marmara University School of Medicine Department of Physical Medicine and Rehabilitation Fevzi Çakmak Mah Muhsin Yazıcıoğlu Cad No 10 Üst Kaynarca Pendik İstanbul Turkey

Maxima Medical Centre De Run 4600 5504 DB Veldhoven Netherlands

Mayo Clinic 200 1st St SW Rochester MN 55905 USA

Mediagnóstica Duitama Cra16 14 68 oficina 201 Duitama Boyacá Colombia

Moncton Hospital 135 Macbeath Ave Moncton New Brunswick E1C 6Z8 Canada

National Cardiovascular Center Harapan Kita Kav 87 Jl Letjen S Parman Jakarta Indonesia

National University Heart Centre Singapore National University Health System Tower Block 1E Kent Ridge Road Level 9 Cardiac Department Singapore 119228 Singapore

Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY United Kingdom

Octubre Universitary Hospital Av Cordoba s n 28041 Madrid Spain

Peiking University People' Hospital 11 Xizhimen S St Xicheng Qu Beijing Shi China

Philippine Heart Center East Avenue Quezon City 1100 Philippines

PHYSIS Prevencion Cardiovascular Cdla Bolivariana Av del Libertador Mz 1 Villa 5 Guayaquil Ecuador

QU Health Qatar University Al Jamiaa St Doha Qatar

Sanggye Paik Hospital Inje University Dongil ro 1342 Nowon gu Seoul Republic of Korea

Shaare Zedek Medical Center the Hebrew University Jerusalem Israel

Ślaskie Centrum Rehabilitacji w Ustroniu Zdrojowa 6 43 450 Ustroń Poland

Sociedad Chilena de Cardiología Alfredo Barros Errázuriz 1954 Providencia Región Metropolitana Chile

Spanish Association Hospital Bulevar Gral Artigas 1471 Montevideo 1471 Uruguay

State Hospital for Cardiology Gyógy tér 2 Balatonfüred 8230 Hungary

Stellenbosch University and International Olympic Committee Research Center South Africa Francie Van Zijl Drive Stellenbosch 7599 South Africa

Tbilisi State Medical University 33 Vazha Pshavela Ave Tbilisi Georgia

The University of Auckland 71 Merton Road Private Bag 92019 Auckland 1142 New Zealand

Universidade Federal de Minas Gerais Av Pres Antônio Carlos 6627 Pampulha Belo Horizonte MG 31270 901 Brazil

University Health Network 399 Bathurst St Toronto ON M5T 2S8 Canada

University of Banja Luka Faculty of Medicine Save Mrkalja 14 78000 Banja Luka Bosnia and Herzegovina

University of British Columbia 2206 East Mall Vancouver British Colombia V6T 1Z3 Canada

University of Iceland Saemundargata 2 IS 101 Reykjavik Iceland

University of Medicine and Pharmacy Victor Babes Cardiovascular Prevention and Rehabilitation Clinic Bvd CD Loga 49 300020 Timisoara Romania

University of Palacky University Hospital Olomouc 1 P Pavlova 185 6 Nová Ulice 779 00 Olomouc Czech Republic

University of the West Indies at Cave Hill St Michael Barbados

York University 4700 Keele Street Toronto Ontario M3J1P3 Canada

Zobrazit více v PubMed

Anderson L., Oldridge N., Thompson D.R. Exercise-based cardiac rehabilitation for coronary heart disease. J Am Coll Cardiol. 2016;67:1–12. PubMed

Thomas R.J., King M., Lui K. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol. 2007;50:1400–1433. PubMed

Woodruffe S., Neubeck L., Clark R.A. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Hear Lung Circ. 2015;24:430–441. PubMed

Grace S.L., Poirier P., Norris C.M. Pan-Canadian development of cardiac rehabilitation and secondary prevention quality indicators. Can J Cardiol. 2014;30:945–948. PubMed

Piepoli M.F., Corra U., Adamopoulos S. Secondary prevention in the clinical management of patients with cardiovascular diseases. Eur J Prev Cardiol. 2014;21:664–681. PubMed

Grace S.L., Parsons T.L., Duhamel T.A. The quality of cardiac rehabilitation in Canada: a report of the Canadian cardiac rehab registry. Can J Cardiol. 2014;30:1452–1455. PubMed

Doherty P., Salman A., Furze G. Does cardiac rehabilitation meet minimum standards: an observational study using UK national audit? Open Hear. 2017;4:1–5. PubMed PMC

Pesah E., Supervia M., Turk-Adawi K. A review of cardiac rehabilitation delivery around the world. Prog Cardiovasc Dis. 2017;60:267–280. PubMed

Smith S.C., Benjamin E.J., Bonow R.O. AHA/ACCF guideline AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update a guideline from the American Heart Association and American College. Circulation. 2011;124:2458–2473. PubMed

Yancy C.W., Jessup M., Bozkurt B. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013. 2013;62:e147–e239. PubMed

Long L., Mordi I.R., Bridges C. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1 PubMed PMC

Hillis L.D., Smith P.K., Anderson J.L. ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2011;124:e652–e735. 2011. PubMed

Levine G.N., Bates E.R., Blankenship J.C. ACCF/AHA/SCAI guideline for percutaneous coronary intervention. J Am Coll Cardiol. 2011;58:1–79. 2012. PubMed

Montalescot G., Sechtem U., Achenbach S. ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003. 2013. PubMed

Sibilitz K.L., Berg S.K., Tang L.H. Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database Syst Rev. 2016;3 PubMed

Anderson L., Nguyen T.T., Dall C.H. Exercise-based cardiac rehabilitation in heart transplant recipients. Cochrane Database Syst Rev. 2017;4 PubMed PMC

Risom S.S., Zwisler A.-D., Johansen P.P. Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev. 2017;2 PubMed PMC

Strategic Commissioning Development Unit Case for change - cardiac rehabilitation services. 2010. https://www.gov.uk/government/publications

Price K.J., Gordon B.A., Bird S.R. A review of guidelines for cardiac rehabilitation exercise programmes: is there an international consensus? Eur J Prev Cardiol. 2016;23:1715–1733. PubMed

Babu A.S., Lopez-Jimenez F., Thomas R.J. Advocacy for outpatient cardiac rehabilitation globally. BMC Health Serv Res. 2016;16:471. PubMed PMC

Buckley J., Doherty P., Furze G. Standards and core components for cardiovascular disease prevention and rehabilitation. 2017. http://www.bacpr.com/resources/AC6_BACPRStandards&CoreComponents2017.pdf London UK. PubMed PMC

Hamm L.F., Sanderson B.K., Ades P.A. Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 2011;31:2–10. PubMed

Gómez-Gonzáleza A., Miranda-Calderínb G., Pleguezuelos-Cobosc E. Recommendations of the Cardio-Respiratory Rehabilitation Society (SORECAR) on cardiac rehabilitation in ischemic heart disease. Rehabilitacion. 2015;49:102–124.

Balady G.J., Chaitman B., Driscoll D. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation. 1998;97:2283–2293. PubMed

Balady G.J., Williams M.A., Ades P.A. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update. Circulation. 2007;115:2675–2682. PubMed

Grace S.L., Turk-Adawi K.I., Contractor A. Cardiac rehabilitation delivery model for low-resource settings. Heart. 2016;102:1449–1455. PubMed PMC

Grace S.L., Turk-Adawi K.I., Contractor A. Cardiac rehabilitation delivery model for low-resource settings: an International Council of Cardiovascular Prevention and Rehabilitation consensus statement. Prog Cardiovasc Dis. 2016;59:1–20. PubMed

Turk-Adawi K., Sarrafzadegan N., Grace S.L. Global availability of cardiac rehabilitation. Nat Rev Cardiol. 2014;11:586–596. PubMed PMC

Ragupathi L., Stribling J., Yakunina Y. Availability, use, and barriers to cardiac rehabilitation in LMIC. Glob Heart. 2016;12:323–334. PubMed

Turk-Adawi K.I., Terzic C., Bjarnason-Wehrens B. Cardiac rehabilitation in Canada and Arab countries: comparing availability and program characteristics. BMC Health Serv Res. 2015;15:521. PubMed PMC

Polyzotis P.A., Tan Y., Prior P.L. Cardiac rehabilitation services in Ontario: components, models and underserved groups. J Cardiovasc Med. 2012;13:727–734. PubMed

Cortes-Bergoderi M., Lopez-Jimenez F., Herdy A.H. Availability and characteristics of cardiovascular rehabilitation programs in South America. J Cardiopulm Rehabil Prev. 2013;33:33–41. PubMed

Bjarnason-Wehrens B., McGee H., Zwisler A.-D. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil. 2010;17:410–418. PubMed

Donabedian A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry. 1988;25:173–192. PubMed

Turk-Adawi K., Supervia Pola M., Lopez Jimenez F. Cardiac rehabilitation availability and density around the globe. eClinicalMedicine. 2019 PubMed PMC

Ghisi G.L.M., Pesah E., Turk-Adawi K. Alternative models of cardiac rehabilitation around the globe. J Clin Med. 2018;7:1–13. PubMed PMC

Chaves G., Turk-Adawi K., Supervia M., Santiago Pio C., Lopez-Jimenez F., Abdel-Hadi R., El-Heneidy A.A., Grace SL. Cardiac rehabilitation dose around the globe: variation and drivers. Circ Cardiovasc Qual Outcomes. 2019 PubMed

Pedersen B.K., Saltin B. 2015. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases; pp. 1–72. Suppl. 3. PubMed

AACVPR . 5th ed. Human Kinetics; Champaign, IL: 2013. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiovascular and secondary prevention programs.

Poffley A., Thomas E., Grace S.L. A systematic review of cardiac rehabilitation registries. Eur J Prev Cardiol. 2017;24:1596–1609. PubMed

Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases