Hybrid and alternative delivery models for cardiac rehabilitation are less expensive and more accessible but globally the number of programs has stagnated creating inequities and increasing the risk of related health issues.

TORONTO, Oct. 9, 2026 鈥� Despite rising incidents of cardiovascular disease (CVD), along with evidence that cardiac rehabilitation programs improve outcomes for those living with CVD, availability of these programs has not increased worldwide in the past decade, according to a new study by 91亚色 researchers.

Availability even for the more affordable hybrid or alternative cardiac rehabilitation programs has not increased since 2016 and is lower than during the pandemic.

The researchers, including 91亚色 and University of Toronto Adjunct Professor Gabriela Lima de Melo Ghisi, 91亚色 Professor Sherry Grace of the Faculty of Health, and 91亚色 grad student Rachael Carson, are surprised and disheartened by the results.

Cardiac rehabilitation is a chronic disease management program proven to reduce death by more than 25 per cent and hospitalization by almost 20 per cent. These programs often begin with patients in the hospital and continue as an outpatient service before moving into a longer-term community-based secondary prevention service. Hybrid programs are both clinic and home-based and are designed to improve outcomes for patients and can involve exercise, healthy living education and stress counselling.

鈥淢ore people around the world are surviving cardiovascular events and living longer with chronic heart disease, yet access to cardiac rehabilitation remains inadequate,鈥� says Lima de Melo Ghisi. 鈥淗ybrid and alternative models can help overcome barriers such as distance and transportation, but our findings show that gains made during the pandemic have not been sustained. Limited reimbursement, staffing and funding continue to constrain these services and contribute to inequities in access.鈥�

Without adequate funding, the costs to run the programs often fall to patients and those in rural areas are particularly disadvantaged if the program is far from where they live.

鈥淢ultiple studies have already shown that cardiac rehabilitation programs work, playing an outsized role in reducing mortality, hospital readmissions and improving quality of life,鈥� says Carson of 91亚色鈥檚 Faculty of Health. 鈥淒espite that, these programs are under-utilized.鈥�

The paper, , was published today in the journal PLOS One.

It is the first global post-pandemic assessment of hybrid and alternative cardiac rehabilitation programs. The number of programs were tallied, including level of reimbursement for them, and countries were compared by income class. Close to 7,000 cardiac rehabilitation programs were identified in 90 countries, but only 286 out of 1,233 programs in 40 of those countries indicated they received reimbursement for the hybrid/alternative models of delivery by government or insurance companies.

In high-income countries like Canada, there were 72,849 cases of ischemic heart disease in 2023 and 380 programs. For the United States, there were 1,144,557 incidents and 2,687 programs. In Japan, there were 292,531 incidents and 678 programs and in Germany there were 362,984 and 155 programs.

Compare this to low-income countries like Afghanistan with 34,207 incidents and zero programs, Ethiopia with 28,903 incidents and zero programs, and outlier Malawi with 3,872 incidents and 23 programs.

Overall, about one-third of responding cardiac rehabilitation programs reported offering a hybrid or alternative model, while fewer than one-quarter reported reimbursement for these models. Among programs offering hybrid or alternative care, almost half (45.8 per cent) reported insufficient capacity to meet demand, most commonly because of staffing and funding constraints.

The results point to the need for not only increased implementation of these programs but for more sustained reimbursement which would go a long way in providing cardiovascular care globally.

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Studies show only 1 cardiac rehab spot exists for every 12 heart attack victims

TORONTO, July 4, 2019聽鈥撀燤ore than 20 million people develop heart disease globally each year, but there is only one cardiac rehab spot for every 12 of those patients to prevent another heart event, according to new research from 91亚色. A global audit and survey of cardiac rehab conducted in 91亚色鈥檚 Faculty of Health showed that cardiac rehab is available in only half of the world鈥檚 countries, and the programs that do exist can only serve 1.65 million patients, leaving a gap of over 18 million patients in need.

This first-ever audit and survey was undertaken through the International Council of Cardiovascular Prevention and Rehabilitation. Heart disease is a chronic condition; 聽cardiac rehabilitation provides heart attack patients structured exercise, risk factor management, as well as education and counselling to optimize their quality of life. Previous research has shown cardiac rehab reduces cardiovascular death and re-hospitalization by 20 percent.

Two papers reporting on the and were published in the journal EClinicalMedicine of the Lancet family today, quantifying how much rehab capacity exists in relation to need in every country, and the quality of programs in countries where it exists. professor in the Faculty of Health at 91亚色 was the senior investigator on the studies, with lead authors Turk-Adawi of Qatar University and Marta Supervia of Gregorio Mara帽贸n General University Hospital.

鈥淎lmost half of countries around the globe have absolutely no cardiac rehab,鈥� said Grace. 鈥淧eople are dying unnecessarily without these programs.鈥�

The goal of the first study was to establish availability of cardiac rehab and capacity to serve patients globally. The global team of 58 investigators established that cardiac rehab programs were available in 55 percent of the approximately 200 countries in the world. Researchers then surveyed all of the almost 6,000 programs and got responses from 93 of the 111 countries with rehab. Programs reported treating fewer than expected patients every year, due primarily to lack of resources.

from this study shows that while Canada ranks among the best in the world for program capacity, cardiac rehab is only available in the provinces, with no programs in the Territories. Overall, there is only one cardiac rehab spot for every 4.5 heart attack patients each year nationally. While Ontario has the most programs, the unmet need for cardiac rehab is greatest there.

Africa and South-East Asia are the regions in the greatest need for more programs. India, China and Russia were the countries in greatest need; each needs millions more rehab spots to treat the average number of patients that develop heart disease each year currently, and unfortunately, that number is expected to grow.

The second study presented the results of the first-ever survey of the cardiac rehab programs worldwide that exist, to find out the nature of services delivered, such as types of patients served, number and types of healthcare professionals on the rehab teams, and services delivered. This study found cardiac rehab programs are of high quality where they are available, and often treat patients with chronic conditions other than heart disease.

The results showed that the existing programs generally met international standards, offering an average of nine out of the 11 recommended core components, but this varied by region. There was inconsistent delivery of interventions for tobacco cessation, managing stress and supporting return-to-work; the situation is the same in Canada. Programs were staffed by an average of 6 staff to deliver these components, generally comprising exercise professionals, nurses, dietitians and physicians.

Researchers say advocacy is needed for more programs that are reimbursed by public healthcare systems or private healthcare insurance. 鈥淚ncreased capacity could be also be achieved by delivering more unsupervised programs 鈥� for example by exploiting technology through home-based cardiac rehabilitation, which was offered in only 38 countries. Delivery in these settings is just as effective at reducing death in heart patients,鈥� says Grace.

The protocol of this global study was endorsed by several international organizations, including the World Heart Federation.

91亚色聽champions new ways of thinking that drive teaching and research excellence. Our students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-disciplinary programming, innovative course design and diverse experiential learning opportunities. 91亚色 students and graduates push limits, achieve goals and find solutions to the world鈥檚 most pressing social challenges, empowered by a strong community that opens minds. 91亚色 U is an internationally recognized research university 鈥� our 11 faculties and 25 research centres have partnerships with 200+ leading universities worldwide. Located in Toronto, 91亚色 is the third largest university in Canada, with a strong community of 53,000 students, 7,000 faculty and administrative staff, and more than 300,000 alumni. 91亚色 U's fully bilingual Glendon Campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education. 聽

Media Contact:聽聽Anjum Nayyar, 91亚色 Media Relations, 416 736 2100 ext. 44543聽anayyar@yorku.ca

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91亚色 U researcher finds amount of cardiac rehab that can lower chances of dying or hospitalization for a heart event

TORONTO, Wednesday, November 8, 2017 鈥� Researchers from 91亚色鈥檚 Faculty of Health and University Health Network have found that heart patients who go to 36 sessions of cardiac rehabilitation require fewer stents, and patients who go to even 12 sessions may have lower chances of dying over the next few years.

Heart disease is among the leading burdens of disease and disability around the world. Many people living with heart disease have repeat heart problems, requiring hospitalization and heart interventions. Cardiac rehab programs are recommended to lower the chance of death and re-hospitalization by 20 per cent. It is known that more cardiac rehab is better, but how much is enough?

In a new study, Professor of 91亚色 U鈥檚 Faculty of Health and Senior Scientist at Toronto Rehabilitation Institute, set out to discover the minimum number of rehab sessions in which patients should take part, to lower their risk of death or hospitalization for a heart event or procedure.

Sherry Grace
Professor, Faculty of Health - School of Kinesiology & Health Science

The research, published in the journal reviewed published studies where patients received different doses of cardiac rehab. They carefully collected information from 33 studies on how many sessions of cardiac rehab patients were prescribed, recorded the corresponding deaths or hospitalizations, and then pooled all the findings.

鈥淧atients need to make sure they get referred to cardiac rehab, and then attend at least 12 sessions-- although attending 36 would bring even better benefits,鈥� says Grace. 鈥淧atients often report barriers to attending, and we need to do all we can to help patients overcome them so they fully participate.鈥�

Currently there is no international standard on the 鈥榙ose鈥� of cardiac rehab required. In Ontario, programs generally offer two sessions per week over five months, or 40 sessions. In the United States they get 36.

Grace says patients would achieve the benefits if they fully take advantage of these cardiac rehab programs, though more study is needed to definitively set a minimum number of sessions. 鈥淐ardiac rehab programs need enough resources in terms of space and staff to offer at least 36 sessions for patients."

is known for championing new ways of thinking that drive teaching and research excellence. Our students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-discipline programming, innovative course design and diverse experiential learning opportunities. 91亚色 students and graduates push limits, achieve goals and find solutions to the world鈥檚 most pressing social challenges, empowered by a strong community that opens minds. 91亚色 U is an internationally recognized research university 鈥搊ur 11 faculties and 26 research centres have partnerships with 200+ leading universities worldwide. Located in Toronto, 91亚色 is the third largest university in Canada, with a strong community of 53,000 students, 7,000 faculty and administrative staff, and more than 295,000 alumni. 91亚色 U's fully bilingual Glendon campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education.

University Health Network One of North America鈥檚 leading rehabilitation sciences centres, Toronto Rehabilitation Institute is revolutionizing rehabilitation by helping people overcome the challenges of disabling injury, illness or age related health conditions to live active, healthier, more independent lives. It integrates innovative patient care, groundbreaking research and diverse education to build healthier communities and advance the role of rehabilitation in the health system.聽 Toronto Rehab, along with Toronto Western, Toronto General and the Princess Margaret Cancer Centre, is a member of the University Health Network and is affiliated with the University of Toronto.

Media Contacts: Anjum Nayyar, 91亚色 Media Relations, 416 736 2100 ext. 44543 anayyar@yorku.ca

Ellen Rosenberg, Toronto Rehab Public Affairs Advisor, 416 597 3422 ext. 3524 ellen.rosenberg@uhn.ca.

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