Improving access to cardiac rehabilitation in Australia: a policy reflection on equitable secondary prevention.

Cardiac rehabilitation (CR) is an evidence-based secondary prevention intervention associated with reduced cardiovascular mortality and hospital readmissions and improved quality of life. Despite strong guideline recommendations, participation remains low in Australia and internationally, particularly among rural and remote populations, Aboriginal and Torres Strait Islander peoples and other underserved populations. This reflects a service delivery challenge rather than an evidence gap. Current CR models remain largely centred on metropolitan hospital-based programs that may not adequately meet the needs of geographically dispersed populations. This policy reflection argues that improving CR participation requires a shift towards more accessible and integrated models of care, including automatic referral pathways, telehealth and hybrid delivery models, stronger primary care involvement and partnerships with Aboriginal Community Controlled Health Organisations. Improving access to CR should be viewed as a broader health system priority with important implications for healthcare equity, chronic disease management and cardiovascular outcomes.