Trends In Cardiac Rehabilitation Uptake And The Use Of Different Program Components

PURPOSE: Cardiac rehabilitation (CR) improves secondary prevention in individuals with cardiovascular diseases (CVD). However, information about the effect of patient- and disease-specific characteristics on CR participation and changes over time are limited. Therefore, the aim of this study was to examine temporal trends in CR participation for different CVD subgroups. Secondly, this study aimed to provide insights into the use of CR program components. METHODS: CVD patients with an indication for CR were enrolled between 2013-2019. Health insurance claims data were used to provide information about CVD diagnosis, CR participation and program components. RESULTS: In total, 106,212 CVD patients were included with a mean age of 68 ± 12 years, and 60% was male. CR participation significantly increased from 2013 to 2016 (i.e., 28% to 41%), but stabilized thereafter. The participation rates followed a similar curve over time across subgroups of age, sex, CVD diagnoses, and cardiothoracic procedures. However, participation was the highest in patients <50 years old (52%), men (48%), and those with a ST-segment elevation myocardial infarction (73%) or coronary artery bypass grafting (82%). The lowest rates were found in patients ≥85 years old (8%), women (30%) and those with heart failure (11%). The time between CVD diagnosis and initiation of CR increased slightly from 29 [IQR 15, 61] to 34 [IQR 19, 63] days between 2013 and 2019. The use of CR components changed marginally over time; admission session from 94% to 97%, exercise training from 78% to 82%, dietary counselling from 7% to 14% and psychological help from 10% to 10%. CONCLUSIONS: CR participation rates increased until 2016. Patient characteristics affected CR participation rates, but the temporal trends followed a similar curve. Most CVD patients attended admission and exercise sessions, but only a small proportion of patients received dietary and psychological counselling. These findings suggest the need for novel strategies to increased CR enrolment in specific CVD subgroups, and for CR components with a low utility.