In a cohort study of 19,080 patients, decentralization of cardiac rehabilitation to primary care settings was associated with increased uptake and significant reductions in geographic and social inequalities.
Decentralization of cardiac rehabilitation significantly reduced median travel distance from patients' homes to the nearest CR facility.
Overall uptake of cardiac rehabilitation increased by 16% following decentralization.
Among patients with the longest travel distances, CR uptake increased by 45% following decentralization, and geographic inequality was significantly reduced.
Among patients with short education, CR uptake increased by 27% following decentralization, and social inequality was significantly reduced.
The study population was predominantly male and aged 60 to 79 years, drawn from patients hospitalized for acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting.
The authors conclude that decentralized delivery of cardiac rehabilitation is a feasible and equitable model, while emphasizing the need for ongoing monitoring of quality and safety.
This research suggests that moving cardiac rehabilitation (CR) programs from centralized hospitals to local, community-based settings—a process called decentralization—can meaningfully increase the number of heart patients who actually participate in these programs. The study followed over 19,000 Danish patients who had experienced a heart attack or undergone a heart procedure between 2013 and 2022. After decentralization, the average distance patients needed to travel to reach a CR facility was cut roughly in half (from about 15 km to about 7 km), and overall participation in at least one rehabilitation session rose by 16%. Importantly, the benefits were greatest for patients who had previously faced the largest barriers. Patients who lived farthest from CR facilities saw a 45% increase in participation, and the gap in participation rates between those living near and far from facilities shrank significantly. Similarly, patients with lower levels of education—a group that historically participates in CR at lower rates—saw a 27% increase in uptake, and the participation gap between more- and less-educated patients was meaningfully reduced. These findings suggest that decentralization helped address both geographic and socioeconomic inequalities in access to cardiac rehabilitation. This research matters because cardiac rehabilitation is known to improve outcomes for heart patients, yet many people who could benefit never participate. Transportation difficulties, long travel distances, and social disadvantage have long been recognized as barriers. This study provides evidence that bringing these programs closer to where people live can help overcome those barriers, particularly for the groups most likely to miss out. The authors note, however, that as these programs expand into community settings, it will be important to continue monitoring whether the quality and safety of care are maintained.
Bihrmann K, Ersbøll A, Svendsen M, Søndergaard H, Zwisler A. (2026). Uptake and Inequalities in Exercise-Based Cardiac Rehabilitation After Decentralization.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.39054