The role and impact of physical medicine and rehabilitation in cardiac rehabilitation programs around the world

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While the role of Physical Medicine and Rehabilitation (PMR) in most areas of medicine is well-established, little is known about the role of PMR in cardiac rehabilitation (CR). This study assessed the frequency with which CR programs were part of PMR departments, how often PMR physicians lead CR programs and were on CR staff, and the impact of this globally for the first time. In this cross-sectional study, an online survey was administered to CR programs globally. National medical associations and local champions facilitated program identification. One hundred and eleven out of 203 (54.7%) countries in the world offer CR, of which data were collected in 93 (83·78%; n = 1082 surveys, 32.1% response). CR was part of a PMR department in 251 (23.19%) programs. Programs had more equipment when they were within PMR departments, such as bicycle ergometers (97.48% vs. 87.69%, P < 0.0001) and body composition analyzers (43.58% vs. 37.05%, P = 0.0172). PMR physicians were the type of provider with overall responsibility in 12.42% ( n = 123) of programs, with the highest rate in Southeast Asia ( n = 12, 38.71%). When responsibility was under PMR, some cardiac indications were more likely to be accepted, such as cardiomyopathy (61.11% vs. 38.89%, P = 0.0005); moreover, alternative CR models (e.g., home-based) were more frequently offered (80.51% vs. 67.13%, P = 0.0024). PMR physicians were part of the team in 389 (43.37%) CR programs. When part of the team, more non-cardiac diagnoses were accepted (34.04% vs. 17.63%, P < 0.0001), like stroke (36.71% vs. 25.32%, P = 0.0005). Overall, 7.07 ± 0.13/10 core components were offered by programs, with a significantly higher number offered where a PMR physician was on the team ( P < 0.0001). We found significant differences among programs based on the PMR involvement in the program. PMR physicians should more often be part of CR programs, as this could result in benefits for patients.