Key result
Utilization interventions increase cardiac rehabilitation enrollment by ~19% vs control.
Why the study?
Access to cardiac rehabilitation remains low globally despite strong evidence of benefit and guideline recommendations, necessitating evaluation of interventions to increase utilisation.
Do interventions to promote utilisation of cardiac rehabilitation improve enrolment, adherence, and completion in adults eligible for cardiac rehabilitation?
Meta-Analysis (n=10,803)
Do interventions to promote utilisation of cardiac rehabilitation improve enrolment, adherence, and completion in adults eligible for cardiac rehabilitation?
Relative Risk: 1.19 (95% CI 1.11–1.29)
A multifaceted approach utilizing patient- and system-level interventions significantly improves cardiac rehabilitation enrolment, adherence, and completion.
BACKGROUND: Despite strong evidence of benefit and guideline recommendation, access to cardiac rehabilitation remains low across global healthcare systems. We provide a 2026 analysis of our previous Cochrane review of randomised trial evidence for interventions designed to increase cardiac rehabilitation enrolment, adherence, and completion. METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, CPCI-S, and trial registries up to 10 March 2025, without language restrictions. We included randomised controlled trials involving adults eligible for cardiac rehabilitation following myocardial infarction, angina, coronary revascularisation, or heart failure. Risk of bias was assessed using the Cochrane tool, and certainty of evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Data on cardiac rehabilitation enrolment, adherence, and completion were pooled using random-effects meta-analysis. RESULTS: A total of 47 trials involving 10,803 participants were included. Most common intervention strategies included: education, self-management training, or motivational interviewing; alternative delivery models (home-based, digital, or hybrid); invitation letters or messaging prompts; and peer support. Compared to control, interventions showed improvements in cardiac rehabilitation program enrolment (relative risk [RR]: 1.19, 95% confidence interval [CI]: 1.11 to 1.29; participants; 27 trials, 7,216 participants; low-certainty evidence), cardiac rehabilitation program adherence (standardised mean difference: 0.32, 95% CI: 0.15 to 0.49; 18 trials, 3,024 participants; moderate-certainty evidence), and cardiac rehabilitation completion (RR:1.22, 95% CI: 1.10 to 1.35; 19 trials, participants: 5,432; moderate-certainty evidence). CONCLUSIONS: To overcome the persistent challenge of suboptimal cardiac rehabilitation utilisation, global healthcare systems should consider a multifaceted approach to improving cardiac rehabilitation utilisation that combines patient- and system-level intervention strategies identified in this review. Further high-quality trials targeting underserved populations are needed in order to optimise equity in future cardiac rehabilitation access.
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Long et al. (2026) conducted a meta-analysis in Myocardial infarction, angina, coronary revascularisation, or heart failure (n=10,803). Interventions to promote utilisation of cardiac rehabilitation vs. Control was evaluated on Cardiac rehabilitation program enrolment (RR 1.19, 95% CI 1.11 to 1.29). Interventions to promote utilisation improved cardiac rehabilitation program enrolment compared to control (RR 1.19; 95% CI 1.11 to 1.29).
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