Plans for the future
Obstacles
Some common health system-related obstacles reported were:
- Insufficient availability of beds and ambulatory facilities (Portugal, France)
- Lack of funding (Latvia, Egypt, Lebanon, Portugal, Greece)
- Uneven geographical distribution of CR centres (Portugal, Spain)
Some professionals-related obstacles were also described, namely:
- Small community CR not routinely being practiced (Israel)
- Insufficient adherence to the guidelines related to professional knowledge and attitude (The Netherlands, Portugal, United Kingdom)
- Insufficient number of cardiopulmonary physiotherapists available (Turkey)
Patient-related obstacles included fear of prolonged absence from work (Germany, Portugal) and poor patient motivation (Portugal, United Kingdom).
Strategies for Secondary Prevention and CR
Innovative solutions for the future proposed in the action plans included:
- The use of CR delivery as an established national health system quality indicator (Israel)
- referral of non-classical CR indications (Israel)
- risk factor counselling reimbursement by insurance companies (Germany)
- continued reinforced intervention up to 3 years after rehabilitation (Italy)
- development of web-based programs (The Netherlands)
- establishment of individualized models of CR (Sweden)
- setup of an educational programme for pupils and their parents (Portugal)
- centre certification to incorporate improvement in exercise capacity/risk reduction outcomes (United Kingdom)
- the support of lagging programmes by the top performing programmes (France)
- frailty tailored CR programs (Challenges in secondary prevention after acute myocardial infarction: A call for action) (1).
In fact, in the framework of the ESC Prevention of CVD Programme, which is led by the EAPC in collaboration with ACCA and CCNAP, a consensus document "Challenges in secondary prevention after acute myocardial infarction: A call for action" (1) was recently published in which some of the existing gaps for secondary prevention strategies were reviewed and effective interventions/innovative strategies in relation to the patients, healthcare providers and healthcare systems were endorsed.
Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.