Availability and trend of dissemination of cardiac rehabilitation in China: report from the multicenter national registration platform between 2012 and 2021

Sisi Zhang; Rongjing Ding; Sikun Chen; Xiaoping Meng; Li Jianchao; Dao Wen Wang; Dayi Hu

doi:10.3389/fcvm.2023.1210068

Availability and trend of dissemination of cardiac rehabilitation in China: report from the multicenter national registration platform between 2012 and 2021

Front Cardiovasc Med. 2023 Jun 19:10:1210068. doi: 10.3389/fcvm.2023.1210068. eCollection 2023.

Authors

Sisi Zhang¹, Rongjing Ding², Sikun Chen³, Xiaoping Meng⁴, Li Jianchao⁵, Dao Wen Wang^#¹, Dayi Hu^#¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Rehabilitation, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
³ Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China.
⁴ Department of Cardiology and Cardiac Rehabilitation, The Affiliated Hospital of Traditional Chinese Medicine, Changchun, China.
⁵ School of Engineering Medicine, Beijing Advanced Innovation for Biomedical Engineering, Beihang University, Beijing, China.

^# Contributed equally.

Abstract

The study aimed to evaluate the current status of cardiac rehabilitation programs in China by registering and tracking patients undergoing CR programs in the database. Data were extracted from the online registry platform of the China Society of Cardiopulmonary Prevention and Rehabilitation from February 2012 to December 2021. Overall, data on 19,896 patients with cardiovascular diseases (CVDs) from 159 hospitals in 34 provinces of China were extracted. From a time point of view, the number of patients who had undergone CR and institutions that perform CR showed the first decline in 2009 and then increased until 2021. From a geographic point of view, the degree of participation varied greatly among regions, most of which were concentrated in eastern parts of China. A higher population of patients who underwent CR were male, aged less than 60 years, with low-a risk for coronary heart disease (CHD), and tended to choose the hospital-based CR program among all cases registered in the database. The top three diseases in the patients who participated in CR were CHD, hypertension, and metabolic syndrome (MS). Centers with CR were more likely to be tertiary-level hospitals. After adjusting for baseline values, there were significant differences in post-CR exercise capacity among the three groups (home-based CR group, hospital-based CR group, and hybrid CR group), which were in favor of the hybrid CR group compared with other groups. The underutilization of CR is a global issue, not just in China. Despite the number of CR programs showing an increasing trend in the past years, CR in China is still in the preliminary stage of development. Furthermore, the participation of CR in China shows wide diversity across geography, disease, age, sex, risk stratification, and hospital-level factors. These findings reinforce the importance of the implementation of effective measures to improve the participation, enrollment in, and uptake of cardiac rehabilitation.

Keywords: availability; cardiac rehabilitation; coronary heart disease; density; exercise capacity.