Cardiac rehabilitation uptake in ESC member countries: heterogeneity and obstacles

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac Rehabilitation (CR) is a multidisciplinary intervention with proved results in patients with cardiovascular (CV) disease. CR penetration status and implementation strategies differ among ESC various members, with different uptake performance according to the results from the latest Overview of CR in ESC member countries (OCRE) report. Purpose To analyse possible implementation factors influencing differential CR phase II uptake after myocardial infarction across OCRE countries. Methods An online survey was sent to all National CV Prevention Coordinators of 51 ESC member countries (champion physicians with deep understanding of their national CR state and easy access to all CR centres for information), to cover important CR demographic, structural and quality control topics. Chi-Square test of independence was performed to find possible statistical associations among surveyed topics with reported average post-MI uptake rate per country. Results Forty-two ESC-affiliated countries answered the survey (82% participation rate): 57% were from the South (n = 24); 62% high income countries, 24% upper middle, 14% lower middle, as defined by the ESC Atlas; 65% (n = 28) followed ESC related guidelines. CR uptake was reported at 0-25% (n = 17), 25-50% (n = 14), 50-75% (n = 7), 75-100% (n = 4). There was a significant correlation between geographic localization and CR patient enrolment, with Northern countries having a higher rate of uptake [X2 (3, n = 42) p = 0,012]. Country wealth did not correlate with CR uptake, but patient low socio-economic status per se, reported as an obstacle by 50% of all countries, showed a positive correlation trend with lower CR enrolment [X2 (3, N = 42), p = 0,07]. A positive association trend between CR predominantly funded by public means and uptake rate was also noted [X2 (3, N = 42), p = 0,08]. Other factors, such as in or outpatient CR delivery predominance or coordination of the program by a cardiologist did not influence the uptake rate. Forty-one percent of the countries reported lack of preventive culture as an obstacle at healthcare level and 16% of them stated cultural issues at patient-level, although no distinct correlation with CR uptake was shown. Conclusions Our analysis shows regional differences between Northern and Southern countries in terms of CR uptake following myocardial infarction. The positive exploratory correlation trends may suggest that social/cultural/financial aspects may play a role in the uptake asymmetries. Specifically powered studies and interaction analysis should be sought in the future concerning those variables in particular.