Clinical Scorecard: Making Cardiac Rehabilitation More Accessible to Patients

At a Glance

Key Highlights

• In 19,080 Danish patients, decentralization reduced median distance to the nearest CR facility from 15.1 to 7.2 km.
• Decentralization was associated with a 16% increase in CR uptake (95% CI, 12%-19%); uptake meant at least one exercise-training session within 180 days after discharge.
• The educational gradient in CR participation was smaller after decentralization.
• Hospital-based, medically supervised CR remains important for patients who are acutely ill or at higher clinical risk.
• The article describes trial evidence that home- or technology-delivered CR with remote professional support can provide health benefits comparable to hospital- or community-based programs.

Guideline-Based Recommendations

Diagnosis

Management

• Consider expanding CR services closer to patients’ homes through community-based delivery.
• Use a spectrum of delivery models, including hospital, community, home, digital, and hybrid approaches, adapted to patients’ clinical needs and preferences.
• Retain medically supervised, hospital-based CR for patients who are acutely ill or face higher clinical risk.

Monitoring & Follow-up

• Assess CR participation after discharge; the Danish study defined uptake as participation in at least one exercise-training session within 180 days.
• Evaluate access across population groups; effects on inequalities by sex, race and ethnicity, and income require further investigation.

Risks

Patient & Prescribing Data

The Danish 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.

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. The article reports that home- or technology-delivered CR with remote professional support can provide comparable health benefits to hospital- or community-based programs.

Clinical Best Practices

• Develop CR delivery options that reduce the distance patients must travel.
• Match the delivery setting to individual clinical needs and preferences.
• Use linked routine health and administrative data to assess service access and outcomes in practice.
• Investigate whether decentralization affects access disparities beyond education, including those related to sex, race and ethnicity, and income.

Related Resources & Content

• Bihrmann and colleagues’ study of decentralization and cardiac rehabilitation access
• References 3 and 4: evidence on benefits of exercise-based cardiac rehabilitation
• Reference 5: cardiac rehabilitation participation in high-income nations
• Reference 6: cardiac rehabilitation availability in low- and middle-income countries