Expert consensus – Cardiac rehabilitation outside cardiac rehabilitation centres, including light private rehabilitation structures and cardiac telerehabilitation

Dany Marcadet, Bruno Pavy, Sonia Corone, Antoine Faure, Marie Michelle Six, Ines Cazaubiel, Jean-Michel Guy, Frédéric Schnell

Despite strong recommendations, cardiac rehabilitation (CR)continues to be underused. In 2019, only 22.3% of patients whohad an acute coronary syndrome underwent CR within 6 monthsof the event. Disparities persist between men (26%) and women(15%), with an average delay of 32 days, and there are significantregional variations (16% in Hauts-de-France compared with 30% in the Centre region, and even lower participation in overseas ter-ritories, e.g. 3.4% in Martinique). Data for other pathologies areunavailable [1]. Across Europe, rehabilitation rates after myocar-dial infarction range from < 25% in 17 countries to 25–50% in 14countries, 50–75% in seven countries and 75–100% in four countries[2]. In the USA, 24% of eligible patients participate in rehabilitation(28.6% men, 18.9% women) [3].French guidelines for CR have been updated, emphasizing itsstrong indications (Type I) for numerous conditions. However,limited accessibility to CR combined with shorter stays in acutecardiology units hamper the optimal initiation of secondary pre-vention [4]. Another reason for the low percentage of patientsundergoing CR is the fact that the current healthcare offering doesnot adequately address patients’ concerns. Indeed, the barriers arenumerous: fear of exercise and the hospital environment; lack ofmotivation; perceived lack of time; lack of prescriptions; family-related difficulties; socioprofessional responsibilities; and distantliving arrangements [5]. This underutilization of CR requires reliable alternatives to reha-bilitation in cardiac rehabilitation centres (CRCs) to be found, withthe aim of better meeting patients’ needs and desires, while main-taining the same level of quality and safety.

• Cardiac rehabilitation

• Light private rehabilitation structures
• Cardiac telerehabilitation

• Background
• Current experiments
• Telerehabilitation in the literature
• onsensus on the management of CR outside specialized CRCs
• Profile of patients eligible for these new CR modalities
• Conclusions

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