Nature of Cardiac Rehabilitation Around the Globe

M. Supervia, K. Turk-Adawi, Francisco Lopez-Jimenez, Ella Pesah, Rongjing Ding, Raquel R. Britto, B. Bjarnason-Wehrens, W. Derman, Ana Abreu, Abraham S. Babu, Claudia Anchique Santos, Seng K. Jong, L. Cuenza, Tee Joo Yeo, Dawn Scantlebury, Karl Andersen, Graciela Gonzalez, Vojislav Giga, D. Vulic, Eleonora VatamanJacqueline Cliff, Evangelia Kouidi, I. Yagci, Chul Kim, Briseida Benaim, Eduardo Rivas Estany, Rosalia Fernandez, Basuni Radi, Dan Gaita, Attila Simon, Ssu Yuan Chen, Brendon Roxburgh, Juan Castillo Martin, Lela Maskhulia, Gerard Burdiat, Richard Salmon, Hermes Lomelí, Masoumeh Sadeghi, Eliska Sovova, Arto Hautala, Egle Tamuleviciute-Prasciene, M. Ambrosetti, Lis Neubeck, Elad Asher, Hareld Kemps, Zbigniew Eysymontt, Stefan Farsky, Jo Hayward, Eva Prescott, S. Dawkes, Claudio Santibanez, Cecilia Zeballos, B. Pavy, Anna Kiessling, N. Sarrafzadegan, Carolyn Baer, Randal Thomas, Dayi Hu, Sherry L. Grace

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


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.

Original languageEnglish
Publication statusPublished - 1 Jan 2019


  • Cardiac rehabilitation
  • Global health
  • Health services
  • Nature
  • Preventive cardiology
  • Survey

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