TORONTO, Oct. 9, 2026 – 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 York University researchers.
Since the pandemic, even for hybrid or alternative cardiac rehabilitation programs which are more affordable to run, the number of programs has decreased even though more people around the world are surviving and living longer with CVD.
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.
The researchers, including York University and University of Toronto Adjunct Professor Gabriela Lima de Melo Ghisi, York Professor Sherry Grace of the Faculty of Health, and York grad student Rachael Carson, are surprised and disheartened by the results.
“An increasing number of people live with chronic cardiac disease with the highest levels in low- and middle-income countries, where about 80 per cent of cardiovascular deaths occur globally. This not only increases economic pressures on these countries, but places further burdens on their health-care systems,” says Lima de Melo Ghisi.
The major roadblock is the lack of funding and staffing for the programs, the cost of which will often fall to patients, creating in inequitable system globally. Other barriers including how far patients live from the program centres and available transportation, particularly in rural areas, and whether they have time in their busy lives between work and family demands. This has led to more home-based and hybrid programs being offered instead as they are less expensive, easier for people to attend, and offer comparable outcomes to clinic- or hospital-based ones, but barriers remain.
“Multiple studies have already shown that cardiac rehabilitation programs work, playing an outsized role in reducing mortality, hospital readmissions and improving quality of life,” says Carson of York’s Faculty of Health. “Despite that, these programs are under-utilized.”
The paper, 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 , 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, hybrid and alternative cardiac rehabilitation programs represented about one third of all programs offered and only one-quarter received reimbursement.
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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PLOS One
Data/statistical analysis
People
9-Oct-2026