Seeking best practices for cardiac rehabilitation registries in Europe

Cardiac rehabilitation has been established as a core component of secondary prevention in cardiovascular diseases (CVDs).1 Its beneficial effects have long been proved by clinical trials and meta-analyses which show a clear reduction in morbidity and mortality in patients after an acute coronary event.2 This worldwide accepted intervention is challenged in everyday clinical life as the demography of population changes, increasing the complexity of cardiac conditions while novel invasive and pharmacological approaches appear. In this variable medical environment it is of apparent importance that cardiac rehabilitation is being delivered effectively to all patients according to clinical practice guidelines through high quality services.3 A well accepted research instrument which helps us to evaluate cardiac rehabilitation programmes so as to improve their efficiency is national and international registries and Poffley et al. in their recent systematic review report on all available cardiac rehabilitation registries.4 The authors provide us with very useful insights regarding the design and execution of these registries as well as barriers, limitations and enablers of implementation. They mention that “well-designed and well-executed registries capture data that reflect ‘real-world’ clinical practice, helping us to evaluate patterns of care and disparities”. This claim immediately raises the question of how we can have a well-design and well-executed cardiac rehabilitation registry so as to gather solid and conclusive data that will help us improve cardiac rehabilitation programmes. Based on this review we may be easily disappointed by the heterogeneity of the registries, which is mainly due to differences in cardiac rehabilitation structure, legislation, funding and national guidelines. But if we take a closer look we easily find out that many registries converge to some certain points which seem to be important for all registry designs. They all, or most of them, collect data on demographics, medical history, anthropometrics, clinical and psychosocial measures, and medication. They use a web-based data-entry method which is an easy and quick way for data collection and may be further improved by technology improvements and novel ‘big data’ methods. The majority collect data at cardiac rehabilitation enrolment and cardiac rehabilitation completion, they are governed by national cardiac rehabilitation working groups within associations and securing patients’ privacy is indisputable.