Temporal trends in cardiac rehabilitation participation and its core components: a nationwide study from the Netherlands

Type of funding sources: None.

Cardiac rehabilitation (CR) is an important secondary prevention strategy for individuals with cardiovascular diseases (CVD)(1). Nevertheless, CR participation rates remain low(2). In the past decade, more attention has been given to CR referral and participation following the development and implementation of (inter)national multidisciplinary CR guidelines(1).

To assess time trends in Dutch CR participation rates between 2013-2019, as well as its distinct components (e.g., admission session, exercise training, nutrition counselling, and psychological help).

CVD patients with a clinical indication for CR were enrolled in this observational study. Health insurance claim data was used to identify CR participation and its components. Temporal trends were analysed using logistic restricted cubic spline regression.

106,212 CVD patients were included, of which 38,954 patients (37%) participated in CR. Participation rates significantly increased from 28% in 2013 to 41% in 2016 but stabilized thereafter. The time trends of participation to CR were mostly similar across different subgroups of age, (Figure 1A), sex (Figure 1B), CVD diagnosis (Figure 1C), and cardiothoracic surgery/procedure (Figure 1D). Participation rates were the highest in younger patients (<50 years; 52%, and 50-65 years; 50%), men (48%), patients with an ST-segment elevation myocardial infarction (73%), and coronary artery bypass grafting (82%). In contrast, participation rates were the lowest in older patients (≥85 years; 8%), women (30%) and in patients with heart failure (11%). Most CR participants received an admission session (97%) and exercise training (82%) during their CR program, whereas nutrition counselling (14%) and psychological help (10%) were underutilized (Figure 2).

CR participation rates increased, but stabilized after 2016. Age, sex, CVD diagnosis and cardiothoracic surgery/procedures affected CR participation rates. Future research and renewed implementation strategies are needed to increase CR referrals, enrolment and participation in specific CVD subgroups and to enhance its potential effectiveness by a higher utilization of modules related to dietary and psychosocial counselling.