Delivery of cardiac rehabilitation through hybrid models and alternative settings by country income classification and decade: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation's 2025 Global Audit Update.

Abstract

Objective Cardiac rehabilitation (CR) is an outpatient model of secondary prevention that improves patient outcomes, yet use remains limited. Hybrid/alternative CR addresses these challenges, but global availability, structure, and volumes have not been characterized since the pandemic. Methods The International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) 2025 Audit Update is a cross-sectional survey of phase II CR programs worldwide. After member Associations supported identification of countries with CR, program data were collected via REDCap between May-September/2025. Data were compared by country income classification, and with prior ICCPR Audits where possible. Results Of 6,905 CR programs identified globally, 1,505 initiated a survey (median program response rate = 62.3% per country) from 90/113 (79.6%) countries with CR. Globally, 286 (23.2%) programs in 40 (35.4%) countries reported reimbursement for hybrid/alternative models, varying significantly by country income class (p Conclusions Hybrid/alternative CR availability has not increased since 2016, and decreased since the pandemic. Reimbursement drives availability, but remains limited and inadequate, frequently shifting costs to patients, constraining services and limiting equitable scale-up.