Coronary rehabilitation programmes in Europe are underused, with poor referral and low participation, according to results of a survey on behalf of the European Society of Cardiology.
The survey concluded there is considerable potential for cardiac rehabilitation programmes to further reduce the risk of fatal and non-fatal cardiovascular events.
Cardiovascular disease, and particularly coronary heart disease, is the leading cause of death in Europe, accounting for 43% of all deaths in men and 55% in women. There are marked differences in prevalence between countries.
The survey, the biggest in Europe on the secondary prevention of heart disease, showed that less than half (44.8%) of all patients with coronary heart disease (CHD) were advised to follow a rehabilitation programme, but only one-third (36.5%) took part in some form of cardiac rehabilitation.
Yet, of those who were advised to attend a programme, four-fifths agreed and did so.
Highest rehabilitation attendance is reported in Lithuania and Ireland, the lowest in Turkey, Cyprus and Russia, and virtually no attendance in Greece and Spain.
"These differences are most likely to reflect the heterogeneity of healthcare systems and the availability of cardiac rehabilitation services in some regions of Europe," said the authors.
* In France 32.4% of CHD patients were advised to attend rehabilitation, and of those advised 90% attended
* In Germany 56.6% were advised, and 91.1% attended
* In Italy 51.5% were advised, and 88.7% attended
* In the UK 43.0% were advised, and 80.6 attended
* In Spain 3% were advised and < 1% attended
The study also found that patients who had coronary artery bypass surgery were more likely to be offered and attend rehabilitation programmes than those in other diagnostic categories.
Smokers, older patients and those with lower educational attainment were also less likely to attend.
Dr Kornelia Kotseva from the National Heart & Lung Institute in London described the results as a major cause for concern.
"There is an urgent need to raise the standard of secondary prevention," she said.
"Although these results are encouraging, there is still considerable potential for cardiac rehabilitation programmes to further reduce the risk of fatal and non-fatal cardiovascular events.
"To achieve the clinical benefits of a prevention programme, we need to integrate professional lifestyle interventions with effective risk factor management and evidence-based drug therapies."
