Cardiac Rehabilitation Availability and Delivery in Europe: How does it Differ by Region and Compare to other High-Income Countries?

Aims To establish:(1a) CR availability and density, as well as (1b) the nature of programs, and (2) compare these (a) by European region (geoscheme) and (b) to other high-income countries (HICs).Methods A survey was administered to CR programs globally. Cardiac associations were engaged to facilitate program identification. Density was computed using Global Burden of Disease study ischemic heart disease (IHD) incidence estimates. Four HICs were selected for comparison (N=790programs)to European data, and multi-level analyses performed. Results CR was available in 40/44(90.9%)European countries. Data were collected in 37(94.8% country response rate). 455/1538 (29.6%response rate) program respondents initiated the survey. Program volumes (median=300) were greatest in Western European countries, but overall were higher than other HICs (p<.001).Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programs were funded by social security (n=25, 59.5%; with significant regional variation, p<0.001), but in 72 (16.0%) patients paid some or all of program costs (or ~ 18.5%of the ~€150.0/program) out-of-pocket. Guideline-indicated conditions were accepted in ≥70% of programs (lower for stable coronary disease), with 4no regional variation. Programs had a multidisciplinary team of 6.5±3.0 staff (number and type varied regionally; and European programs had more staff than other HICs), offering 8.5±1.5/10 core components (consistent with other HICs) over 24.8±26.0hours (regional differences, p<0.05). Conclusion European CR capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.