Overview of Cardiac Rehabilitation following post-acute myocardial infarction in European Society of Cardiology member countries

Lay Summary Since cardiovascular disease (CVD) is a leading cause of mortality and morbidity, this work sought to characterize the current state of cardiac rehabilitation (CR), an important therapeutic tool comprising multidisciplinary interventions to manage cardiovascular risk, in Europe. Current positive aspects of CR in Europe include low dropout rates and short average start time after myocardial infarction, as well as public funding being standard practice. Suboptimal aspects of CR in Europe include low uptake rates and short average duration, a lack of CR mandatory rotation in cardiology training, guidance documents, lack of national accreditation, and electronic database registries. Although provision of CR is at an encouraging level in Europe, it often is of suboptimal quality, signalling the need for improvement in the allocation of human and monetary resources. This study also highlighted the following major barriers to the implementation and use of the cardiovascular prevention and rehabilitation guidelines: low socioeconomic status and educational level, older age, lack of benefit awareness, presence of comorbidities, transportation problems and financial concern (at patient level), lack of automatic referral, no financial incentives, lack of multidisciplinary teams and time consumption (at staff level), and reimbursement issues, lack of preventive culture, lack of specialized locations, and geographical issues (at healthcare level). Aims Cardiovascular disease (CVD) is still a leading cause of death and morbidity in Europe and must be addressed through approaches beyond therapeutic interventions and pharmacological management. Cardiac rehabilitation (CR) is a comprehensive, individualized, and patient-tailored programme, comprising multidisciplinary interventions. Despite its clinical benefits, cost-effectiveness, and existing guidelines, CR uptake in Europe remains suboptimal and detailed information on its current state is lacking. This centralized pan-European study (Overview of Cardiac Rehabilitation-OCRE) aimed to characterize and advance the knowledge about European Society of Cardiology (ESC) affiliated national CR settings. Methods and results An online survey about provision and quality indicators from CR was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national experts. The OCRE study had a high participation rate (82%). Current positive aspects of CR include low dropout rates and short average start time after myocardial infarction, as well as public funding being standard practice. However, the uptake rate and average duration of CR are still suboptimal, and several countries lack CR mandatory rotation in Cardiology training, guidance documents, national accreditation, and electronic database registries. We also found several barriers to CR guideline implementation, at patient, staff, and healthcare levels. Conclusions This study provides a comprehensive characterization of CR in Europe, generating important insight on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles.