Overview of Cardiac Rehabilitation (OCRE) in European Society of Cardiology (ESC) Member Countries

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite unambiguous guideline recommendations, the implementation of Cardiac Rehabilitation (CR), a cost-effective strategy of secondary prevention with the potential to reduce cardiovascular morbi-mortality, remains heterogeneous, mostly suboptimal, in Europe. A previous "Overview of CR in ESC member countries" (OCRE) analysis reported on diverse national uptake rates and singled out possible common CR provision and quality surrogates contributing to the distinct performances. However, an integrated understanding of the overall status and concomitancy of the provision and quality indicators (or the lack thereof) in each country was still lacking. Purpose The present OCRE analysis aimed to further characterize and compare ESC affiliated national CR settings, by scoring the national overall provision and quality status, and to describe the matching between both. Methods An online survey concerning key CR provision and quality indicators was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national expert consensuses. To summarize the findings from the OCRE study, we assigned participating countries based on their provision of CR and their CR quality, to three different categories: lacking, average, and good. Provision was rated considering the following indicators: uptake rate, dropout rate, average start time, average duration, and public funding. CR quality was sought by scoring the presence of: guidelines, guidance documents, coordination by cardiology, mandatory rotation in cardiology training, national accreditation, and electronic database registry. Results The data suggested that although provision of CR is at an encouraging level in Europe (Fig.1), it often is of suboptimal quality (Fig.2), signalling the need for improvement in the allocation of human and monetary resources. Conclusions This study provides a comprehensive characterisation of CR in Europe, generating important insights on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles. Particularly, we consider that European CR programs need to be based upon the same minimal quality standards. However, we acknowledge the differences in economy, culture, religion, health system, climate, and literacy across the different countries. These need to be considered and respected, and a shared CR plan should contemplate the diver sity and promote adjustments for each country while also preventing it from falling short of the common set goals.