Barriers to the Availability and Effectiveness of Cardiac Rehabilitation
https://doi.org/10.18087/cardio.2025.12.n3039
Abstract
It has been proven and widely accepted that comprehensive cardiac rehabilitation that underlies secondary prevention reduces morbidity, disability, and mortality from cardiovascular diseases and their complications, improves quality of life, and minimizes economic losses to the healthcare system and the state as a whole. Unfortunately, despite the recognized benefits of cardiac rehabilitation, it remains underutilized or inadequately utilized. In addition to the common barriers to participation in rehabilitation that occur in most countries, the Russian Federation faces a number of limiting factors related to discrepancies between current regulations and clinical guidelines on cardiac rehabilitation, which critically impacts the rehabilitation of cardiac patients. To address this issue, it would be appropriate to separate cardiac rehabilitation from the "medical rehabilitation of patients with somatic diseases." This situation requires cardiologists to create a consensus document on cardiac rehabilitation, which should address organizational issues, routing, a description of cardiac rehabilitation programs with proven effectiveness, and criteria of the rehabilitation effectiveness specific to cardiac patients. Therefore, this should be a document aimed at reducing mortality, complications, disability, and increasing the life expectancy of cardiac patients, which is the primary goal of healthcare.
About the Authors
S. A. PomeshkinaRussian Federation
Leading Researcher, Research Laboratory of Rehabilitation, Doctor of Sciences (Medicine)
E. A. Demchenko
Russian Federation
Chief Researcher of the Research Laboratory of Rehabilitation, Doctor of Sciences (Medicine)
N. P. Lyamina
Russian Federation
Professor, head of the cardiology department, professor of chair of cardiology, postgraduate training faculty, Doctor of Sciences (Medicine)
M. G. Glezer
Russian Federation
Professor, head of chair of cardiology, postgraduate training faculty, Doctor of Sciences (Medicine)
O. L. Barbarash
Russian Federation
Director, Professor, Academician of the Russian Academy of Sciences, Doctor of Sciences (Medicine)
References
1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Executive Summary: Heart Disease and Stroke Statistics – 2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):447–54. DOI: 10.1161/CIR.0000000000000366
2. Federal State Statistics Service. Health in Russia. 2023. Statistical book. - M.: Rosstat; 2023. - 179p. Av. at: http://ssl.rosstat.gov.ru/storage/mediabank/Zdravoohran-2023.pdf
3. Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2021;28(5):460–95. DOI: 10.1177/2047487320913379
4. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends in Cardiovascular Medicine. 2017;27(6):420–5. DOI: 10.1016/j.tcm.2017.02.005
5. Anderson L, Oldridge N, Thompson DR, Zwisler A-D, Rees K, Martin N et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease. Journal of the American College of Cardiology. 2016;67(1):1–12. DOI: 10.1016/j.jacc.2015.10.044
6. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler A-D et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2021;2021(11):CD001800. DOI: 10.1002/14651858.CD001800.pub4
7. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post–myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American Heart Journal. 2011;162(4):571-584.e2. DOI: 10.1016/j.ahj.2011.07.017
8. Bauer TM, Yaser JM, Daramola T, Mansour AI, Ailawadi G, Pagani FD et al. Cardiac Rehabilitation Reduces 2-Year Mortality After Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery. 2023;116(5):1099–105. DOI: 10.1016/j.athoracsur.2023.05.044
9. Bjarnason-Wehrens B, Nebel R, Jensen K, Hackbusch M, Grilli M, Gielen S et al. Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis. European Journal of Preventive Cardiology. 2020;27(9):929–52. DOI: 10.1177/2047487319854140
10. Campo G, Tonet E, Chiaranda G, Sella G, Maietti E, Bugani G et al. Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial. Heart. 2020;106(21):1658–64. DOI: 10.1136/heartjnl-2019-316349
11. Bokeria L.A., Aronov D.M. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. CardioSomatics. 2016;7(3–4):5–71. DOI: 10.26442/CS45210
12. Averkov O.V., Arutyunyan G.K., Duplyakov D.V., Konstantinova E.V., Nikulina N.N., Shakhnovich R.M. et al. 2024 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation electrocardiogram. Russian Journal of Cardiology. 2025;30(5):127–216. DOI: 10.15829/1560-4071-2025-6319
13. Averkov O.V., Arutyunyan G.K., Duplyakov D.V., Konstantinova E.V., Nikulina N.N., Shakhnovich R.M. et al. 2024 Clinical practice guidelines for Acute myocardial infarction with ST segment elevation electrocardiogram. Russian Journal of Cardiology. 2025;30(3):121–207. DOI: 10.15829/1560-4071-2025-6306
14. Barbarash O.L., Karpov Yu.A., Panov A.V., Akchurin R.S., Alekyan B.G., Alekhin M.N. et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):166–229. DOI: 10.15829/1560-4071-2024-6110
15. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. DOI: 10.1161/CIR.0b013e3182742cf6
16. Kim C, Sung J, Lee JH, Kim W-S, Lee GJ, Jee S et al. Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome. Korean Circulation Journal. 2019;49(11):1066–111. DOI: 10.4070/kcj.2019.0194
17. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Revista Española de Cardiología (English Edition). 2022;75(5):429. DOI: 10.1016/j.rec.2022.04.003
18. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal. 2021;42(1):17–96. DOI: 10.1093/eurheartj/ehaa605
19. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):e574–651. DOI: 10.1161/CIR.0b013e31823ba622
20. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):2610–42. DOI: 10.1161/CIR.0b013e31823b5fee
21. Bubnova M.G., Barbarash O.L., Doletsky A.A., Krasnitsky V.B., Lebedeva E.V., Lyamina N.P. et al. Acute ST elevation myocardial infarction: aftercare and secondary prevention. National Russian guidelines. Russian Journal of Cardiology. 2015;20(1):6–52. DOI: 10.15829/1560-4071-2015-1-6-52
22. Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC et al. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006;113(19):2363–72. DOI: 10.1161/CIRCULA-TIONAHA.106.174516
23. Nordanstig J, Behrendt C-A, Baumgartner I, Belch J, Bäck M, Fitridge R et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. European Journal of Vascular and Endovascular Surgery. 2024;67(1):9–96. DOI: 10.1016/j.ejvs.2023.08.067
24. Butchart EG, Gohlke-Bärwolf C, Antunes MJ, Tornos P, De Caterina R, Cormier B et al. Recommendations for the management of patients after heart valve surgery. European Heart Journal. 2005;26(22):2463–71. DOI: 10.1093/eurheartj/ehi426
25. Nytrøen K, Gullestad L. Effect of Exercise in Heart Transplant Recipients. American Journal of Transplantation. 2013;13(2):527. DOI: 10.1111/ajt.12046
26. Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458–73. DOI: 10.1161/CIR.0b013e318235eb4d
27. Alter DA, Yu B, Bajaj RR, Oh PI. Relationship Between Cardiac Rehabilitation Participation and Health Service Expenditures Within a Universal Health Care System. Mayo Clinic Proceedings. 2017;92(4):500–11. DOI: 10.1016/j.mayocp.2016.12.024
28. Lubinskaya E.I., Nikolaeva O.B., Demchenko E.A. Impact of patient cardiac rehabilitation participation after coronary artery bypass surgery on treatment cost and input pattern. Translational Medicine. 2014;2:52–7.
29. Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018;104(17):1403–10. DOI: 10.1136/heartjnl-2017-312809
30. Lubinskaya E.I., Demchenko E.A., Svetun´kov S.G. Modeling and evaluation of the effectiveness of multidisciplinary cardiac rehabilitation. - SPb.: Publishing House of the Saint Petersburg University of Economics; 2014. - 126p. ISBN 978-5-7310-3045-8
31. Darba S, Safaei N, Mahboub–Ahari A, Nosratnejad S, Alizadeh G, Ameri H et al. Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran. Risk Management and Healthcare Policy. 2020;13:969–78. DOI: 10.2147/RMHP.S261612
32. Hautala AJ, Kiviniemi AM, Mäkikallio T, Koistinen P, Ryynänen OP., Martikainen JA et al. Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome. Scandinavian Journal of Medicine & Science in Sports. 2017;27(11):1395–403. DOI: 10.1111/sms.12738
33. Lubinskaya E.I., Demchenko E.A., Malinin A.M. Investment approach to assessing the economic efficiency of medical interventions (using coronary artery bypass grafting as an example). Health Care Manager. 2013;9:12–20.
34. Kondrikova N.V., Pomeshkina S.A., Barbarash O.L. Patient after coronary artery bypass grafting. Focus for recovery of labour ability. Siberian Medical Review. 2017;5(107):109–14. DOI: 10.20333/2500136-2017-5-109-114
35. Bubnova M.G., Aronov D.M., Boytsov S.A., Ivanova G.E., Andreev A.G., Barbarash O.L. et al. Cardiorehabilitation organization in Russia. The results of the pilot project ‘Development of the system of rehabilitation of patients with cardiovascular diseases in medical institutions of the Russian Federation’. CardioSomatics. 2016;7(3–4):72–81.
36. Turk-Adawi K, Sarrafzadegan N, Grace SL. Global availability of cardiac rehabilitation. Nature Reviews Cardiology. 2014;11(10):586–96. DOI: 10.1038/nrcardio.2014.98
37. Sandesara PB, Lambert CT, Gordon NF, Fletcher GF, Franklin BA, Wenger NK et al. Cardiac Rehabilitation and Risk Reduction: time to ‘rebrand and reinvigorate’. Journal of the American College of Cardiology. 2015;65(4):389–95. DOI: 10.1016/j.jacc.2014.10.059
38. Ades PA, Keteyian SJ, Wright JS, Hamm LF, Lui K, Newlin K et al. Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clinic Proceedings. 2017;92(2):234–42. DOI: 10.1016/j.mayocp.2016.10.014
39. Ministry of Health of the Russian Federation. Order N 788n from 31.07.2020 «On approval of the Procedure for the organization of medical rehabilitation of adults». Av. at: http://publication.pravo.gov.ru/Document/View/0001202009250036.
40. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. The American Journal of Medicine. 2004;116(10):682–92. DOI: 10.1016/j.amjmed.2004.01.009
41. World Health Organization. Needs and action priorities in cardiac Rehabilitation and secondary prevention in patients with coronary heart disease. WHO regional office for Europe; Geneva: 1993.
42. Bubnova M, Aronov D, Barbarash O, Lyamina N, Pomeshkina S, Chumakova G et al. A Nationwide pilot project to develop rehabilitation services for patients with cardiovascular diseases. Journal of Rehabilitation Medicine. 2021;53(4):jrm00186. DOI: 10.2340/16501977-2833
43. Davos CH, Rauch B. Evidence for cardiac rehabilitation in the modern era. [DOI: 10.1093/med/9780198849308.003.0001]. In: ESC Handbook of Cardiovascular Rehabilitation. - Oxford University Press; 2020. – 224p. ISBN: 978-0-19-884930-8
44. Ministry of Health of the Russian Federation. Order of the ministry of health of Russia, November 15, 2012. № 918н «On approval of the procedure for organizing medical care to patients with cardiovascular diseases». Av. at: https://base.garant.ru/70299174/.
45. Kontsevaya A.V., Veretennikova A.V., Rozanov V.B., Khudyakov M.B., Drapkina O.M. Characteristics of a 1-year outpatient management of patients after myocardial infarction: data from a Russian multicenter study. Russian Journal of Cardiology. 2022;27(5):56–63. DOI: 10.15829/1560-4071-2022-5004
46. Pogosova N.V., Boytsov S.A. Preventive Cardiology 2024: State of Problem Perspectives of Development. Kardiologiia. 2024;64(1):4–13. DOI: 10.18087/cardio.2024.1.n2636
47. Gulyaeva-Seltsovskaya E.P., Dkhif I., Vitalieva K.D., Roshchupkina P.S., Simonyan A.O., Tkachev M.I. et al. Incidence of cardiac events in on-pump elective surgical interventions on the aorta and heart valves. Russian Journal of Cardiology. 2023;28(9):82–8. DOI: 10.15829/1560-4071-2023-5484
48. Sumin A.N., Bezdenezhnykh A.V., Ivanov S.V., Barbarash O.L., Barbarash L.S. Multifocal atherosclerosis in patients with ischemic heart disease: the impact of immediate results of coronary artery bypass grafting. Russian Heart Journal. 2014;13(1):11–7.
49. Bubnova M.G., Aronov D.M. Clinical effects of a one-year cardiac rehabilitation program using physical training after myocardial infarction in patients of working age with different rehabilitation potentials. Cardiovascular Therapy and Prevention. 2019;18(5):27–37. DOI: 10.15829/1728-8800-2019-5-27-37
Review
For citations:
Pomeshkina S.A., Demchenko E.A., Lyamina N.P., Glezer M.G., Barbarash O.L. Barriers to the Availability and Effectiveness of Cardiac Rehabilitation. Kardiologiia. 2025;65(12):5-12. (In Russ.) https://doi.org/10.18087/cardio.2025.12.n3039
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