Comparisons of core component delivery in cardiac rehabilitation programs by country income classification and decade based on the 2025 Global Audit Update: A survey study
by Gabriela Lima de Melo Ghisi, Rachael P. Carson, Karam Turk Adawi, Rongjing Ding, Warner M. Mampuya, Mariya P. Jiandani, Jimena Martinez, Monserrat Cruz Rivero, Claudia V. Anchique, Dinah L. van Schalkwijk, Jonathan Gallagher, Buket Akinci, Dion Candelaria, Jirapa Champaiboon, Daniel F. Quesada-Chaves, Tone M. Norekvål, Iwona Szadkowska, Borut Jug, Evangelia Kouidi, Marta Supervia, Won-Seok Kim, Chamila Mettananda, Lilian Mbau, Gulsim T. Aimakova, Sherry L. Grace, on behalf of the ICCPR Global Cardiac Rehabilitation Audit Update Investigators Background Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p