Country income classification significantly impacted cardiac rehabilitation delivery, with upper-middle-income countries offering more core components (median 9) than low-income countries (6) (p<0.001).
Cross-Sectional (n=1,505)
Yes
A global survey of 1,505 cardiac rehabilitation programs shows continued guideline-concordant care delivery, though resource availability and risk factor assessment remain lower in lower-income countries.
p-value: p=<0.001
Background Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p 90%; median = 11; p25, p75 = 8, 14). Resource availability differed significantly by country income class (GLMM p < 0.001), with programs in upper-middle-income countries reporting more resources than those in high-income (mean difference = 1.5), lower-middle-income (mean difference = 2.6), and low-income countries (mean difference = 4.8; all p < 0.001). While there were no significant differences in total resources, resistance training equipment, electronic patient charts, body composition analyzers, and stress testing with O 2 were more available in 2025, and the availability of administrative office space and group education room less so (ps < .01). Limitations include potential selection and ascertainment bias from incomplete program identification as well as variable, modest program response rates, limited representation from low-income settings, reliance on self-reported survey data, as well as measurement differences across Audit cycles, which may affect generalizability and precision of findings. Conclusions CR programs worldwide continue to deliver guideline-concordant care, with education potentially shifting modality. However, modest inequities persist for resource-constrained programs.
Ghisi et al. (Tue,) conducted a cross-sectional in Cardiovascular disease (cardiac rehabilitation programs) (n=1,505). Country income classification vs. Other income classifications was evaluated on Core components delivered, risk factors assessed, patient education dose, and program resources (p=<0.001). Country income classification significantly impacted cardiac rehabilitation delivery, with upper-middle-income countries offering more core components (median 9) than low-income countries (6) (p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: