Cardiac rehabilitation coverage and program characteristics in Latin America and the Caribbean: Comparisons from the ICCPR's 2025 Global Audit Update.
Cardiac rehabilitation (CR) is a proven, cost-effective secondary prevention intervention. Latin America and the Caribbean (LAC) bears a disproportionate burden of cardiovascular diseases yet limited CR availability. This Global Audit aimed to characterize CR coverage and delivery (access, staffing, core components, dose) in LAC, comparing findings with ICCPR's 2016 Audit and current global data.
Between May-September 2025, any phase II CR programs in all 35 LAC countries were identified through local Societies and surveyed (REDCap). Ischemic heart disease incidence was extracted from the Global Burden of Disease study 2023 estimates to reflect CR need, and juxtaposed with annual program volume data.
CR was available in 25 (71.4%) LAC countries, comprising 337 programs-a 32.2% increase from 2016. Responses were received from 255 programs in 19 (76.5%) countries with CR. Based on need, the total estimated service shortfall across the region was 635,945 patients/year, with a median of 2.9% coverage/country. Systematic CR referral was infrequent (6.3%), except in Chile. Fewer patients were paying out-of-pocket, but were paying more where they were. Using purchasing power parity, delivery costs per program were significantly lower in LAC than globally (p<.001). Multidisciplinary teams comprised 5 (median; P25-P75=3.8-7.0) members. Programs delivered 9/10 (P25-P75=7.0-10.0) core components, with patient education nearly universal, but tobacco cessation interventions-while increased from 2016-still lower than globally. Alternative model availability remained relatively unchanged from 2016 at <20%, and lower than that globally (29.5%). Total median dose was 25 sessions per supervised program, and 12/patient in alternative models.
High-quality CR persists, but system-level shortfalls limit impact.
Between May-September 2025, any phase II CR programs in all 35 LAC countries were identified through local Societies and surveyed (REDCap). Ischemic heart disease incidence was extracted from the Global Burden of Disease study 2023 estimates to reflect CR need, and juxtaposed with annual program volume data.
CR was available in 25 (71.4%) LAC countries, comprising 337 programs-a 32.2% increase from 2016. Responses were received from 255 programs in 19 (76.5%) countries with CR. Based on need, the total estimated service shortfall across the region was 635,945 patients/year, with a median of 2.9% coverage/country. Systematic CR referral was infrequent (6.3%), except in Chile. Fewer patients were paying out-of-pocket, but were paying more where they were. Using purchasing power parity, delivery costs per program were significantly lower in LAC than globally (p<.001). Multidisciplinary teams comprised 5 (median; P25-P75=3.8-7.0) members. Programs delivered 9/10 (P25-P75=7.0-10.0) core components, with patient education nearly universal, but tobacco cessation interventions-while increased from 2016-still lower than globally. Alternative model availability remained relatively unchanged from 2016 at <20%, and lower than that globally (29.5%). Total median dose was 25 sessions per supervised program, and 12/patient in alternative models.
High-quality CR persists, but system-level shortfalls limit impact.
Authors
Ghisi Ghisi, Anchique Anchique, Cruz Rivero Cruz Rivero, Fernández Fernández, Quesada-Chaves Quesada-Chaves, Martinez Martinez, Seron Seron, Turk-Adawi Turk-Adawi, Jiandani Jiandani, Mbau Mbau, Supervia Supervia, Carson Carson, Grace Grace, , Radi Radi, Jug Jug, Akinci Akinci, Mettananda Mettananda, Candelaria Candelaria, van Schalkwijk van Schalkwijk, Kouidi Kouidi, Aimakova Aimakova, Szadkowska Szadkowska, Champaiboon Champaiboon, Gallagher Gallagher, Batalik Batalik, Maskhulia Maskhulia, Yokoyama Yokoyama, Gaye Gaye, Chen Chen, Norekyal Norekyal, Mampuya Mampuya, Kim Kim, Ding Ding, Hautala Hautala
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