Making Cardiac Rehabilitation More Accessible to Patients

By
Rod S. Taylor
October 14, 2026

Jama Network Open

Overview

A Danish registry-linked observational study of 19,080 patients found that decentralizing cardiac rehabilitation (CR) was associated with shorter travel distances, a 16% increase in uptake, and a smaller educational gradient in participation. The editorial describes these findings as support for expanding services closer to patients while retaining hospital-based care for people who are acutely ill or at higher clinical risk.

Background

Exercise-based CR is associated with fewer hospitalizations, lower related health care costs, reduced risk of nonfatal cardiovascular events, and better health-related quality of life among people with coronary heart disease or heart failure. Despite these benefits and guideline endorsement, participation remains limited, including in high-income countries, and CR programs are scarce in many low- and middle-income countries. The editorial highlights Denmark’s CPR number as an infrastructure that enables linkage of individual-level administrative and health data across national registries. Bihrmann and colleagues used this linkage to examine whether moving CR from hospitals to community-based services was associated with improved access.

Data Highlights

Measure	Finding
Study population	19,080 patients with coronary heart disease discharged after acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting
Study setting	21 of Denmark’s 98 municipalities
Median distance to nearest CR facility	Decreased from 15.1 km to 7.2 km after decentralization
CR uptake	Increased by 16% (95% CI, 12%–19%)
Uptake definition	Participation in at least one exercise-training session within 180 days after hospital discharge
Educational gradient	Decentralization was associated with a smaller educational gradient in CR participation

Key Findings

CPR-number linkage enabled researchers to connect Danish administrative and health registries to assess CR access and participation.
The analysis included 19,080 patients with coronary heart disease discharged after acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting in 21 municipalities.
After CR provision was decentralized, the median distance from patients’ homes to the nearest facility fell from 15.1 km to 7.2 km.
Decentralization was associated with a 16% increase in CR uptake (95% CI, 12%–19%); uptake meant attending at least one exercise-training session within 180 days of discharge.
The study also found a smaller educational gradient in participation after decentralization; effects across other dimensions of inequality, including sex, race and ethnicity, and income, require further investigation.
The editorial reports that trial evidence indicates home- or technology-delivered CR with remote professional support can provide health benefits comparable to hospital- or community-based programs, while noting the continuing role of medically supervised hospital programs for acutely ill or higher-risk patients.

Clinical Implications

The editorial supports developing and expanding CR services closer to patients’ homes, while maintaining medically supervised hospital-based programs for patients who are acutely ill or at higher clinical risk. It describes a range of delivery options—including hospital, community, home, digital, and hybrid models—as relevant to patients’ clinical needs and preferences.

Conclusion

The Danish study demonstrates how linked routine data can assess access to an established intervention in practice and identify patterns in participation. Its findings associate decentralization with increased CR uptake and a smaller educational gradient, while leaving effects across other dimensions of inequality for further investigation.