University of Oulu

Abreu, A., Pesah, E., Supervia, M., Turk-Adawi, K., Bjarnason-Wehrens, B., Lopez-Jimenez, F., Ambrosetti, M., Andersen, K., Giga, V., Vulic, D., Vataman, E., Gaita, D., Cliff, J., Kouidi, E., Yagci, I., Simon, A., Hautala, A., Tamuleviciute-Prasciene, E., Kemps, H., … Grace, S. L. (2019). Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? European Journal of Preventive Cardiology, 26(11), 1131–1146.

Cardiac rehabilitation availability and delivery in Europe : how does it differ by region and compare with other high-income countries? : endorsed by the European Association of Preventive Cardiology

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Author: Abreu, Ana1; Pesah, Ella2; Supervia, Marta3;
Organizations: 1Cardiology Department, Hospital Santa Maria, Portugal
2Department of Kinesiology and Health Sciences, York University, Canada
3Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Spain
4Department of Public Health, Qatar University, Qatar
5Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
6Department of Cardiovascular Medicine, Mayo Clinic, USA
7Istituti Clinici Scientifici Maugeri, Care and Research Institute Department of Cardiac Rehabilitation, Italy
8Department of Internal Medicine, University of Iceland, Iceland
9Institute of Cardiovascular Diseases, Clinical Center of Serbia, Serbia
10University of Banja Luka, Center for Medical Research, Bosnia and Herzegovina
11Institute of Cardiology, Moldova Academy of Science, Republica Moldova
12University of Medicine and Pharmacy ‘‘Victor Babes’’, Cardiovascular Prevention and Rehabilitation Clinic, Romania
13Cardiac Rehabilitation Department, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, UK
14Department of First Internal Medicine, Aristotle University of Thessaloniki, Greece
15Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Turkey
16Cardiac Rehabilitation Department, State Hospital for Cardiology, Hungary
17Cardiovascular Research Group, Oulu University Hospital, Finland
18Department of Rehabilitation, Lithuanian University of Health Sciences, Lithuania
19Department of Cardiology, Maxima Medical Centre, The Netherlands
20Cardiac Rehabilitation Department, S ´ laskie Centrum Rehabilitacji w Ustroniu, Poland
21Cardiology Department, Heart House Martin, Slovakia
22Cardiology Department, Bispebjerg Frederiksberg Hospital, Denmark
23School of Health and Social Care, Edinburgh Napier University, UK
24Cardiac Rehabilitation Department, Loire-Vende´e-Oce´an Hospital, France
25Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Sweden
26Department of Internal Medicine, University of Palacky, University Hospital Olomouc, Czech Republic
27Toronto Rehabiliation Institute, University Health Network, Canada
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: SAGE Publications, 2019
Publish Date: 2020-04-30


Aims: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries.

Methods: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using global burden of disease study ischaemic heart disease incidence estimates. Four high-income countries were selected for comparison (N = 790 programmes) to European data, and multilevel analyses were performed.

Results: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries (P < 0.001). 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 programmes 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 the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences, P < 0.05).

Conclusion: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.

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Series: European journal of preventive cardiology
ISSN: 2047-4873
ISSN-E: 2047-4881
ISSN-L: 2047-4873
Volume: 26
Issue: 11
Pages: 1131 - 1146
DOI: 10.1177/2047487319827453
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was supported by a minor research grant provided by the York University Faculty of Health.
Copyright information: © The European Society of Cardiology 2019. Reprinted by permission of SAGE Publications. The Definitive Version of Record can be found online at: