Staffing, Accepted Indications and Dose of Phase II Cardiac Rehabilitation: Country Income Class and Time-Based Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) 2025 Audit Update.

AIMS: To characterize global variation in cardiac rehabilitation (CR) staffing, indications, and prescribed dose by country income classification, and compare findings with the International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) 2016 Global Audit.

METHODS

Cross-sectional REDCap survey of phase II/post-discharge CR programs (May-September 2025). Outcomes were multidisciplinary team size/composition, accepted cardiac and non-cardiac indications, and centre-based CR dose. Comparisons were made across World Bank country income classifications and Audit decade (2016 vs 2025).

RESULTS

Of 7,025 programs identified globally, 1,505 (median program response rate=62%/country) initiated a survey, from 90/113 (80%) countries with CR. CR was delivered by a multidisciplinary team of 7 (median; P25-P75=5-8; nurses, physiotherapists, cardiologists, and dietitians most common); teams were smaller in low-income countries (median=4; p<0.001), and physician specialty varied. Non-low-income programs consistently accepted (≥90%) patients with acute coronary syndrome, with programs in low-income countries less often accepting related interventions (e.g., surgery: low-income 0% vs high-income 97%; p<0.01), but non-cardiac indications were more frequently accepted (e.g., primary prevention, diabetes, lung disease). Acceptance of heart failure increased compared with the previous Audit (70% vs 87%; p<0.001). Centre-based programs prescribed a median of 20 hours (P25-P75=12-30), typically two sessions/week over eight weeks. Globally, 65 (72%) countries prescribed a median ≥12 sessions/program. Programs in upper-middle-income countries prescribed more sessions (median=24, P25-P75=12-36; p<0.001). Dose did not differ meaningfully between Audits (p=0.07).

CONCLUSION

CR programs globally are offered by small, but multidisciplinary teams. They accept guideline-indicated patients, with applicable variation by context. Insufficient dose in one-quarter of countries underscores investment need.