Interventions to Promote Utilisation of Cardiac Rehabilitation: 2026 Cochrane Systematic Review and Meta-Analysis.

BACKGROUND

Despite strong evidence of benefit and guideline recommendation, access to cardiac rehabilitation remains low across global healthcare systems. We provide a 2026 analysis of our previous Cochrane review of randomised trial evidence for interventions designed to increase cardiac rehabilitation enrolment, adherence, and completion.

METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, CPCI-S, and trial registries up to 10 March 2025, without language restrictions. We included randomised controlled trials involving adults eligible for cardiac rehabilitation following myocardial infarction, angina, coronary revascularisation, or heart failure. Risk of bias was assessed using the Cochrane tool, and certainty of evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Data on cardiac rehabilitation enrolment, adherence, and completion were pooled using random-effects meta-analysis.

RESULTS

A total of 47 trials involving 10,803 participants were included. Most common intervention strategies included: education, self-management training, or motivational interviewing; alternative delivery models (home-based, digital, or hybrid); invitation letters or messaging prompts; and peer support. Compared to control, interventions showed improvements in cardiac rehabilitation program enrolment (relative risk [RR]: 1.19, 95% confidence interval [CI]: 1.11 to 1.29; participants; 27 trials, 7,216 participants; low-certainty evidence), cardiac rehabilitation program adherence (standardised mean difference: 0.32, 95% CI: 0.15 to 0.49; 18 trials, 3,024 participants; moderate-certainty evidence), and cardiac rehabilitation completion (RR:1.22, 95% CI: 1.10 to 1.35; 19 trials, participants: 5,432; moderate-certainty evidence).

CONCLUSIONS

To overcome the persistent challenge of suboptimal cardiac rehabilitation utilisation, global healthcare systems should consider a multifaceted approach to improving cardiac rehabilitation utilisation that combines patient- and system-level intervention strategies identified in this review. Further high-quality trials targeting underserved populations are needed in order to optimise equity in future cardiac rehabilitation access.