Cardiac rehabilitation referral and access by country income class: Comparisons from the International…

Cross-sectionalEuropean journal of internal medicine· Jul 2026

Cardiac rehabilitation referral and access by country income class: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's 2025 Global Audit Update.

Rachael P Carson, Sherry L Grace, Karam Turk Adawi … Gabriela L M Ghisi

Cardiopulmonary RehabilitationCross-sectionalQ1IF 3.6

Cost was estimated to keep half of patients from attending cardiac rehabilitation.

Cardiac rehabilitation referral and access by country income class: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's 2025 Global Audit Update.

Rachael P Carson … Gabriela L M Ghisi

European journal of internal medicine · Jul 2026 · Q1 in General Medicine

Purpose

To characterize CR: (1) referral practices, (2) systematic referral barriers, (3) wait listing, (4) program-level approaches to mitigating patient access barriers, as well as (5) CR reimbursement sources; compared by country income classification and Audit decade.

Methods

Were leads from phase II/post-discharge CR programs offering at least initial assessment, structured aerobic exercise, and ≥1 other core component.

n = 1,505/7,025 CR programs

Results

cost alone kept half of patients from ever starting rehab

63%

Government

45%

Patients

26%

Insurance

More results

1,505/7,025 CR programs identified globally initiated a survey from 90/113 countries with CR.

Of programs situated in a hospital, 87% had inpatient cardiology services, most commonly referring before discharge (62%).

Programs offered tailored CR information to patients (61%) in multiple formats/modalities.

More results

Programs contacted no-shows (67%) and discussed patient-related barriers (63%), with access optimization strategy variation by income class (p<0.05).

“

Conclusion

Programs are implementing evidence-based patient engagement approaches, but reimbursement inequities undermine access globally.

Cardiac rehabilitation referral and access by country income class: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's 2025 Global Audit Update.

Cardiac rehabilitation referral and access by country income class: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's 2025 Global Audit Update.

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