RECREA: Registry of cardiac rehabilitation centers in Latin America of the council of cardiac rehabilitation and sports cardiology of the Inter-American Society of Cardiology

BACKGROUND AND OBJECTIVES: Despite economic and social disparities in Latin America (LA), a better understanding of cardiovascular disease (CVD) has driven regional growth in parallel with the evolution of therapeutic interventions. Cardiac rehabilitation (CR) is an interdisciplinary treatment that has expanded over the past 50 years. Consequently, several regional, continental, and global registries have emerged to understand its structure and operation worldwide. However, there is a lack of information on the evolution of these programs, their characteristics, and associated outcomes in Latin America. We aimed to characterize the geographical distribution of CR centers, their operational characteristics, their Phase II and III therapeutic offerings, and their main clinical results in Latin American countries. METHODS: This was a multinational survey-based registry involving 31 countries invited to participate through cardiac rehabilitation specialists designated as "sentinels", national cardiology societies/associations, previous registries, professional networks, and an Inter-American Society of Cardiology (SIAC) campaign. The survey consisted of 66 variables divided into 4 domains: general characteristics, program structure, offerings, and outcomes. RESULTS: Eighteen of the 31 countries responded, with 256 of 320 programs participating, representing an 80.0% response rate; 71.5% of these were private centers. No formal CR was identified in 13 countries. There were 43,956 patients seen annually across the 256 centers, resulting in an estimated average of 172 patients per center/year. Due to their population density, Mexico, Brazil, Argentina, and Colombia are the countries that serve the largest number of patients and have the smallest coverage gap. CR delivery is heterogeneous in terms of monitoring, delivery, and referral pathways. Barriers to access are primarily financial and related to transportation, rather than a lack of access or patient comorbidities. Phase II programs are characterized by being mostly concurrent and short, but with a high volume of patients, and are heavily based on educational care strategies. Strengths include the emergency medical system, interdisciplinarity, inclusion of diverse heart conditions, back-referral systems, and center-reported favorable clinical results, especially in cardiorespiratory and physical fitness, the psycho-emotional sphere, and risk factor control. Adherence to Phase III was 57.3 ± 24.4%. CONCLUSIONS: CR capacity across LA remains heterogeneous, highlighting significant disparities in access and delivery across countries, with substantial gaps in referral and coverage. However, there is an expanded inclusion of various cardiovascular conditions, a comprehensive level of interdisciplinarity, professionalization, safety, and reported effectiveness in Phase II. These findings provide actionable data for health systems planning and the expansion of CR services in the region.