Objective:

To summarize evidence on whether decentralizing cardiac rehabilitation (CR) services in Denmark improved access for patients with coronary heart disease.

Approach:

• Study design and data: Bihrmann and colleagues linked national administrative and health registries using Denmark’s CPR identifier to study 19,080 patients discharged after acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting in 21 muni…
• Access measure: CR uptake was defined as attending at least one exercise-training session within 180 days after hospital discharge.

Key Findings:

• After CR services were decentralized from hospitals to community settings, median distance from patients’ homes to the nearest facility fell from 15.1 to 7.2 km.
• CR uptake increased by 16% (95% CI, 12%-19%).
• Decentralization was associated with a smaller educational gradient in CR participation.

Interpretation:

The article reports that locating CR services closer to patients was associated with higher uptake and a smaller educational disparity. Effects across other dimensions of inequality, including sex, race and ethnicity, and income, require further investigation.

Limitations:

• The reported analysis concerns patients in 21 of Denmark’s 98 municipalities.
• The article notes that effects across sex, race and ethnicity, and income have not been established.

Conclusion:

The authors describe decentralized community services as one component of a broader range of CR delivery models, alongside hospital-based, home, digital, and hybrid programs. They emphasize that observational studies complement randomized trials by examining access and inequalities in routine care.

Sources:

• Article context provided by the user