Table 1
Numbers of participating hospitals, numbers of recruited patients and numbers and proportions of patient-reported referral to a CR programme, by country.
| NUMBER OF CENTRES | NUMBER OF RECRUITED PATIENTS | REFERRAL TO A CR PROGRAMME* | |
|---|---|---|---|
| Argentina | 7 | 193 | 14.6% (28/192) |
| China | 10 | 400 | 12.4% (49/396) |
| Colombia | 7 | 399 | 56.2% (221/393) |
| Egypt | 4 | 289 | 12.4% (34/274) |
| Indonesia | 7 | 406 | 58.2% (235/404) |
| Kenya | 3 | 126 | 4.0% (5/125) |
| Malaysia | 5 | 402 | 28.4% (111/391) |
| Nigeria | 12 | 242 | 29.4% (65/221) |
| Philippines | 6 | 401 | 29.7% (116/390) |
| Poland | 9 | 299 | 69.6% (208/299) |
| Portugal | 6 | 408 | 39.4% (160/406) |
| Singapore | 6 | 400 | 44.8% (174/388) |
| Tanzania | 2 | 179 | 7.5% (13/174) |
| UAE | 4 | 404 | 24.9% (65/261) |
| Total | 88 | 4548 | 34.4% (1484/4314*) |
[i] *N = 234 patients answered ‘Don’t know’ to the question.
Table 2
Association between patient characteristics and referral to a CR programme.
| REFERRED TO PARTICIPATE IN A CR PROGRAMME | |
|---|---|
| Sex | |
| Male | 35.0% (1193/3412) |
| Female | 32.3% (291/902) |
| p = 0.13 | |
| Age at recruiting event | |
| <55 years | 35.7% (528/1480) |
| 55–64 years | 36.0% (567/1575) |
| ≥65 years | 30.9% (389/1259) |
| p = 0.0078 | |
| Recruiting event | |
| Elective CABG | 70.4% (209/297) |
| Elective PCI | 25.5% (240/941) |
| Acute myocardial infarction STEMI | 38.0% (528/1389) |
| Acute myocardial infarction Non-STEMI | 38.0% (339/893) |
| Unstable angina/acute myocardial ischaemia | 21.2% (168/794) |
| p < 0.0001 | |
| Educational level* | |
| Low | 23.9% (263/1102) |
| Intermediate | 38.6% (832/2157) |
| High | 37.2% (386/1039) |
| p < 0.0001 | |
| Occupational status | |
| Full time employed | 38.9% (742/1909) |
| Part time employed | 36.5% (62/170) |
| Self employed | 30.8% (224/728) |
| Unemployed | 21.7% (48/221) |
| Retired | 32.8% (334/1017) |
| Other | 27.3% (72/264) |
| p < 0.0001 | |
| Hospitalizations prior to the recruiting event | |
| Elective CABG | |
| No | 34.2% (1429/4184) |
| Yes | 42.0% (47/112) |
| p = 0.088 | |
| Elective PCI | |
| No | 34.4% (1249/3629) |
| Yes | 33.5% (220/656) |
| p = 0.69 | |
| STEMI or NSTEMI | |
| No | 33.6% (1232/3669) |
| Yes | 40.3% (213/528) |
| p = 0.0028 | |
| Unstable angina/Acute myocardial ischaemia | |
| No | 34.3% (1380/4024) |
| Yes | 34.2% (68/199) |
| p = 0.99 | |
| Angina pectoris | |
| No | 34.5% (1360/3940) |
| Yes | 32.3% (96/297) |
| p = 0.49 | |
| Stroke | |
| No | 34.4% (1438/4185) |
| Yes | 37.5% (42/112) |
| p = 0.48 | |
| Transient ischaemic attack | |
| No | 34.2% (1460/4263) |
| Yes | 38.5% (10/26) |
| p = 0.68 | |
| Heart failure | |
| No | 34.3% (1438/4197) |
| Yes | 37.5% (33/88) |
| p = 0.57 | |
| Peripheral artery disease | |
| No | 34.4% (1460/4249) |
| Yes | 30.3% (10/33) |
| p = 0.72 |
[i] Note: significances obtained by using Fishers’ exact test.
*Educational level was categorised as low (primary school or lower), high (university or higher), or intermediate (all points between low and high).
Table 3
Attendance in a CR programme by country.
| N | PATIENT ATTENDANCE* | |||
|---|---|---|---|---|
| NO | <50% OF SESSIONS | ≥50% OF SESSIONS | ||
| Argentina | 28 | 92.9% (26) | 3.6% (1) | 3.6% (1) |
| China | 49 | 24.5% (12) | 57.1% (28) | 18.4% (9) |
| Colombia | 221 | 17.6% (39) | 14.9% (33) | 67.4% (149) |
| Egypt | 34 | 44.1% (15) | 41.2% (14) | 14.7% (5) |
| Indonesia | 235 | 21.3% (50) | 20.4% (48) | 58.3% (137) |
| Kenya | 5 | 0.0% (0) | 40.0% (2) | 60.0% (3) |
| Malaysia | 111 | 30.6% (34) | 9.9% (11) | 59.5% (66) |
| Nigeria | 64 | 70.3% (45) | 9.4% (6) | 20.3% (13) |
| Philippines | 116 | 38.8% (45) | 21.6% (25) | 39.7% (46) |
| Poland | 208 | 11.5% (24) | 2.4% (5) | 86.1% (179) |
| Portugal | 160 | 15.0% (24) | 6.3% (10) | 78.8% (126) |
| Singapore | 174 | 36.2% (63) | 17.2% (30) | 46.6% (81) |
| Tanzania | 13 | 46.2% (6) | 30.8% (4) | 23.1% (3) |
| UAE | 65 | 36.9% (24) | 18.5% (12) | 44.6% (29) |
| All | 1483** | 27.4% (407) | 15.4% (229) | 57.1% (847) |
[i] *Among those who were referred to a CR programme; **For 1 referred patient the information on the actual attendance in a CR programme was missing.
Table 4
Association between patient characteristics and attendance in a CR programme (at least half of the sessions).
| ATTENDANCE IN A CR PROGRAMME % ATTENDING AT ≥50% OF THE SESSIONS | |
|---|---|
| Sex | |
| Male | 57.0% (680/1192) |
| Female | 57.4% (167/291) |
| p = 0.95 | |
| Age at recruiting event | |
| <55 years | 53.5% (282/527) |
| 55–64 years | 57.0% (323/567) |
| ≥65 years | 62.2% (242/389) |
| p = 0.031 | |
| Recruiting event | |
| Elective CABG | 68.9% (144/209) |
| Elective PCI | 52.5% (126/240) |
| AMI STEMI | 56.6% (299/528) |
| AMI Non-STEMI | 61.8% (209/338) |
| Unstable angina/myocardial ischaemia | 41.1% (69/168) |
| p < 0.0001 | |
| Educational level | |
| Low | 45.6% (120/263) |
| Intermediate | 59.9% (498/832) |
| High | 58.8% (227/386) |
| p = 0.00021 | |
| Occupational status | |
| Full time employed | 59.1% (438/741) |
| Part time employed | 53.2% (33/62) |
| Self employed | 41.1% (92/224) |
| Unemployed | 41.7% (20/48) |
| Retired | 67.7% (226/334) |
| Other | 52.8% (38/72) |
| p < 0.0001 | |
| Income | |
| Low | 45.5% (171/376) |
| Middle | 59.0% (566/960) |
| High | 66.7% (54/81) |
| p < 0.0001 |
Table 5
Content of the cardiac rehabilitation programme (reported by the patients).
| PLEASE SPECIFY WHAT YOU RECEIVED AS PART OF THIS PROGRAMME | |||||||
|---|---|---|---|---|---|---|---|
| WRITTEN MATERIALS | SUPERVISED EXERCISE PROGRAMME | HEALTH PROMOTION WORKSHOPS | STRESS MODIFICATION AND RELAXATION | DIET/WEIGHT MODIFICATION | SMOKING CESSATION* | OTHER | |
| Argentina | 50.0% (1) | 50.0% (1) | 100.0% (2) | 0.0% (0) | 0.0% (0) | — | 50.0% (1) |
| China | 10.8% (4) | 75.7% (28) | 5.4% (2) | 8.1% (3) | 24.3% (9) | 50.0% (4) | 0.0% (0) |
| Colombia | 46.7% (85) | 50.5% (92) | 36.3% (66) | 17.6% (32) | 29.7% (54) | 9.7% (3) | 0.0% (0) |
| Egypt | 68.4% (13) | 47.4% (9) | 42.1% (8) | 52.6% (10) | 63.2% (12) | 45.5% (5) | 0.0% (0) |
| Indonesia | 22.2% (41) | 94.1% (174) | 44.9% (83) | 33.5% (62) | 47.0% (87) | 36.8% (28) | 0.5% (1) |
| Kenya | 20.0% (1) | 80.0% (4) | 20.0% (1) | 20.0% (1) | 60.0% (3) | — | 0.0% (0) |
| Malaysia | 46.8% (36) | 79.2% (61) | 55.8% (43) | 40.3% (31) | 46.8% (36) | 52.2% (12) | 0.0% (0) |
| Nigeria | 31.6% (6) | 10.5% (2) | 47.4% (9) | 15.8% (3) | 42.1% (8) | 50.0% (1) | 5.3% (1) |
| Philippines | 47.8% (33) | 65.2% (45) | 33.3% (23) | 26.1% (18) | 40.6% (28) | 17.4% (4) | 1.4% (1) |
| Poland | 72.8% (134) | 91.3% (168) | 59.2% (109) | 76.6% (141) | 79.3% (146) | 52.5% (32) | 1.1% (2) |
| Portugal | 64.7% (86) | 91.7% (122) | 60.9% (81) | 60.2% (80) | 72.2% (96) | 59.7% (37) | 1.5% (2) |
| Singapore | 70.3% (78) | 83.8% (93) | 33.3% (37) | 11.7% (13) | 26.1% (29) | 21.7% (5) | 1.8% (2) |
| Tanzania | 28.6% (2) | 28.6% (2) | 28.6% (2) | 28.6% (2) | 57.1% (4) | — | 0.0% (0) |
| UAE | 63.4% (26) | 41.5% (17) | 29.3% (12) | 19.5% (8) | 24.4% (10) | 16.7% (2) | 0.0% (0) |
| Total | 51.0% (546) | 76.4% (818) | 44.6% (478) | 37.7% (404) | 48.7% (522) | 40.1% (133) | 0.9% (10) |
[i] *For patients smoking in the month prior to hospital admission.
Table 6
Lifestyle related characteristics according to attendance at CR programmes.
| ATTENDANCE (IF REFERRED) | |||
|---|---|---|---|
| NO OR <50% OF SESSIONS | ≥50% OF SESSIONS | SIGNIFICANCE | |
| Smoking1, % | 20.8% (132/636) | 13.2% (112/847) | p = 0.0001 |
| Persistent smoking2, % | 54.0% (122/226) | 40.3% (104/258) | p = 0.0034 |
| Overweight3, % | 64.2% (408/636) | 66.9% (566/846) | p = 0.27 |
| Obesity4, % | 21.9% (139/636) | 22.9% (194/846) | p = 0.66 |
| Central overweight5, % | 65.4% (415/635) | 68.0% (575/845) | p = 0.29 |
| Central obesity6, % | 33.4% (212/635) | 34.6% (292/845) | p = 0.66 |
| Physical inactivity7, % | 64.5% (410/636) | 52.4% (444/847) | p < 0.0001 |
[i] 1Self-reported current smoking or >10 ppm carbon monoxide in breath; 2Self-reported smoking or >10 ppm carbon monoxide in breath in patients reporting to be a smoker in the month prior to the recruiting event; 3Body mass index (BMI) ≥25 kg/m2; 4BMI ≥30 kg/m2; 5 Waist circumference ≥80 cm for women and ≥94 cm for men (South Asian and Chinese men ≥90 cm); 6Waist circumference ≥88 cm for females and ≥102 cm for males; 7Not performing regular physical activity ≥30 minutes on average 5 times a week
Table 7
Achievement of blood pressure, LDL-cholesterol and HbA1c targets.
| ATTENDANCE (IF REFERRED) | |||
|---|---|---|---|
| NO OR <50% OF SESSIONS | ≥50% OF SESSIONS | SIGNIFICANCE | |
| (a) All patients | |||
| Systolic/diastolic BP | |||
| ≥130/80 mmHg, % | 62.9% (400/636) | 53.8% (456/847) | p = 0.0006 |
| ≥140/90 mmHg, % | 33.3% (212/636) | 25.6% (217/847) | p = 0.0014 |
| ≥160/100 mmHg, % | 8.5% (54/636) | 5.8% (49/847) | p = 0.049 |
| LDL cholesterol | |||
| ≥1.4 mmol/L, % | 86.7% (510/588) | 79.9% (617/772) | p = 0.0011 |
| ≥1.8 mmol/L, % | 65.3% (384/588) | 57.1% (441/772) | p = 0.0025 |
| ≥2.5 mmol/L, % | 32.3% (190/588) | 27.2% (210/772) | p = 0.041 |
| Diabetes1 | |||
| Self-reported, % | 43.7% (278/636) | 39.0% (330/847) | p = 0.070 |
| Newly diagnosed diabetes2, % | 12.0% (36/299) | 8.3% (29/348) | p = 0.15 |
| IGT3, % | 19.7% (59/299) | 26.0% (107/412) | p = 0.059 |
| (b) Treated patients | |||
| Systolic/diastolic blood pressure4 | |||
| <130/80 mmHg, % | 38.1% (219/575) | 45.8% (366/799) | p = 0.0048 |
| <140/90 mmHg, % | 68.0% (391/575) | 74.1% (592/799) | p = 0.015 |
| <160/100 mmHg, % | 91.8% (528/575) | 93.9% (750/799) | p = 0.16 |
| LDL cholesterol5 | |||
| <1.4 mmol/L, % | 14.1% (72/510) | 20.9% (150/716) | p = 0.0026 |
| <1.8 mmol/L, % | 36.9% (188/510) | 44.6% (319/716) | p = 0.0081 |
| <2.5 mmol/L, % | 70.2% (358/510) | 74.9% (536/716) | p = 0.078 |
| HbA1c in patients with diabetes6 | |||
| <53 mmol/mol (7.0%), % | 54.9% (135/246) | 62.9% (188/299) | p = 0.066 |
| <64 mmol/mol (8.0%), % | 78.0% (192/246) | 82.9% (248/299) | p = 0.16 |
[i] 1Including those reporting the use of glucose lowering drugs; 2According to OGTT-data: fasting glucose ≥7.0 mmol/L and/or 2h-postload glucose ≥11.1 mmol/L in patients without self-reported diabetes; 3IGT impaired glucose tolerance: Fasting plasma glucose <7.0 mmol/l and 2h glucose ≥7.8 and <11.1 mmol/l in patients without self-reported diabetes; 4In patients using beta-blockers, ACE inhibitors, angiotensin II receptor blockers, renin inhibitors, calcium channel blockers, diuretics or other anti-hypertensive drugs; 5In patients using statins, fibrates, nicotinic acid, cholesterol absorption inhibitors, PCSK9 inhibitors, resins or a fixed-dose combination of lipid lowering drugs; 6In patients with self-reported diabetes or using insulin, metformin, sulphonylurea, incretins (gliptins and/or GLP1 analogs), glinides, glitazones, SGLT2 inhibitors or alpha-glucosidase inhibitors.
Table 8
Reported cardio-protective medication and medication adherence comparing non-participants with participants.
| ATTENDANCE (IF REFERRED) | |||
|---|---|---|---|
| NO OR <50% OF SESSIONS | ≥50% OF SESSIONS | SIGNIFICANCE | |
| Antiplatelets/anticoagulants1, % | 94.9% (600/632) | 95.2% (805/846) | p = 0.90 |
| Beta-blockers, % | 78.0% (492/631) | 83.7% (707/845) | p = 0.0058 |
| ACE inhibitors/ARBs2, % | 65.3% (413/632) | 70.6% (597/846) | p = 0.036 |
| Lipid-lowering drugs3, % | 87.8% (555/632) | 92.9% (786/846) | p = 0.0010 |
| The four drug pillars’, % | 49.8% (314/631) | 56.9% (481/845) | p = 0.0071 |
| High-intensity statins, % | 61.9% (390/630) | 64.4% (542/842) | p = 0.35 |
| Medication adherence* | |||
| Lipid-lowering drugs, % | 90.8% (545/600) | 96.1% (788/820) | p < 0.0001 |
| Blood-pressure-lowering drugs, % | 91.9% (514/559) | 96.9% (757/781) | p < 0.0001 |
| Glucose-lowering drugs, % | 91.6% (274/299) | 95.8% (367/383) | p = 0.034 |
[i] 1Including NOACs; 2Including renin inhibitors; 3Statins, fibrates, nicotinic acid, cholesterol absorption inhibitors, PCSK9 inhibitors, resins, or a fixed-dose combination of lipid-lowering drugs.
Table 9
Distribution of the INTERASPIRE Guideline Target Score for achieving lifestyle, risk factor, and therapeutic targets.
| PARTICIPATION (IF ADVISED) | |||
|---|---|---|---|
| NO OR <50% OF SESSIONS | ≥50% OF SESSIONS | SIGNIFICANCE | |
| Guideline Target Score | p < 0.0001 | ||
| 0–5, % | 26.5% (152/574) | 14.4% (109/757) | |
| 6–7, % | 49.0% (281/574) | 50.1% (379/757) | |
| 8–10, % | 24.6% (141/574) | 35.5% (269/757) | |