Cardiac rehab lifeline failing to reach patients

Almost 400,000 people who experience an acute coronary syndrome (ACS) event every year are missing out on cardiac rehabilitation programs, despite compelling evidence that these interventions dramatically cut the risk of death from a repeat heart attack.

Cardiac rehabilitation is a clinically recommended intervention for all patients recovering from ACS, including those who undergo revascularisation procedures such as percutaneous coronary intervention (PCI). Delivered as an outpatient program over six to eight weeks, it combines structured exercise, self-management education, and psychosocial support to help patients regain health and prevent future cardiac events.

Yet new research led by Monash University has exposed a significant gap between evidence and reality where only 20% of eligible cardiac patients in Victoria are attending rehabilitation programs.

The study, involving more than 7,000 patients, demonstrated that those who fail to participate in cardiac rehabilitation have higher unplanned hospital readmissions and are four times more likely to die from another cardiac event compared with those who complete the program.

“The reduced risk of dying from further cardiac events was directly related to the number of cardiac rehabilitation sessions attended,” said study lead Dr Susie Cartledge from Monash University. “Despite these programs having been shown to significantly reduce repeat heart attacks, short-term all-cause hospitalisation, increase health related quality of life and reduce long term cardiovascular mortality, while being cost effective, their uptake in Victoria remains very poor.”

A key barrier identified by the study was the failure of eligible patients to be referred into rehabilitation pathways by cardiologists and healthcare systems.

“Less than half of eligible Australians are referred to cardiac rehabilitation after an acute cardiac event,” Dr Cartledge said, referring to previous studies from her lab from the same dataset (VCOR) which showed that the referral rate for PCI patients was high at 85 per cent, “…so it was really disappointing to see that only 19.3 per cent of those went to cardiac rehab.”

“Lack of attendance at cardiac rehabilitation programs is multifaceted but is driven by lack of referral, lack of patient’s understanding about the importance of attending, and the fragmented systems between inpatient and outpatient care,” she added.

Digital innovation is emerging as a potential solution. Cardihab’s digital rehabilitation program for cardiac patients has reported higher completion rates of 80% compared with 47% for traditional models. The program reduced hospital bed days by 71% and is also a more cost-effective alternative.

Yet despite mounting evidence supporting digital therapeutics (DTx) and remote patient monitoring (RPM), Australia’s policy and funding settings have struggled to keep pace. Existing reimbursement structures remain largely built around face-to-face models of care, leaving digital solutions without a clear or consistent pathway.

International markets have moved faster. Germany’s DiGA program, France’s LATM and PECAN frameworks, and the United States Medicare RPM billing model have accelerated digital health adoption, supporting broader patient access while easing strain on health systems.

For Cardihab, securing sustainable funding has been patchy. While most private health insurers now support access to the platform and statewide implementation has been achieved through the Tasmanian Health Service, the absence of a national reimbursement pathway continues to limit equitable access for all eligible patients.

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