Dinah L. van Schalkwijk

Background: Cardiovascular disease (CVD) remains a leading global health burden. Cardiac rehabilitation (CR) is essential to reducing morbidity and improving patient outcomes. Since the COVID-19 pandemic, CR delivery worldwide has evolved, yet these changes have not been systematically charactemkjrized. The objective of this study was to characterize globally: (1) the delivery of core CR components, including risk factors assessed, patient education practices, and program resources; (2) differences in these elements by country income classification and relative to the initial 2016 Global CR Audit. Methods and findings: A cross-sectional Audit update was conducted. Program-level data were collected from May 1st to September 1st 2025 using a REDCap survey adapted from previous Audits. Eligible respondents were leads of phase II/post-discharge CR programs providing at least an initial assessment, structured aerobic exercise, and ≥1 additional core component. ICCPR associations and local leaders supported program identification. Main outcomes were core components delivered (10 assessed), risk factors assessed (14 assessed), patient education dose (hours/patient/program), and program resources (17 assessed). Generalized linear mixed models (GLMM) tested differences by income classification and (when applicable) changes since 2016. Of 7,025 programs identified globally, 1,505 (62% median country response rate) initiated a survey from 90/113 (80%) countries with CR. The median number of core components offered was 8/program (p25, p75 = 6, 10), with upper-middle income countries offering significantly more components overall (median = 9), and also high-income countries offering more than low-income countries (8 versus 6, p < 0.001; decade change not tested). Programs assessed 11 risk factors/program (median; p25, p75 = 8, 12). This significantly differed by country income class (GLMM p < 0.001), with programs in lower-middle income countries assessing fewer risk factors than those in both upper-middle-income (mean difference = 2.2; p < 0.001) and high-income countries (mean difference = 1.6, p < 0.001). There were significant increases in 2025 for glucose, sleep apnea and sedentariness, among others (ps < 0.01). Patient education dose was 3 hours/supervised program (median; p25, p75 = 1, 7), a significant reduction in many high-income countries since 2016 ( p = 0.01). Globally, gym space, resistance training equipment, and individual assessment/counseling space were the most common resources (all >90%; median = 11; p25, p75 = 8, 14). Resource availability differed significantly by country income class (GLMM p < 0.001), with programs in upper-middle-income countries reporting more resources than those in high-income (mean difference = 1.5), lower-middle-income (mean difference = 2.6), and low-income countries (mean difference = 4.8; all p < 0.001). While there were no significant differences in total resources, resistance training equipment, electronic patient charts, body composition analyzers, and stress testing with O ₂ were more available in 2025, and the availability of administrative office space and group education room less so (ps < .01). Limitations include potential selection and ascertainment bias from incomplete program identification as well as variable, modest program response rates, limited representation from low-income settings, reliance on self-reported survey data, as well as measurement differences across Audit cycles, which may affect generalizability and precision of findings. Conclusions: CR programs worldwide continue to deliver guideline-concordant care, with education potentially shifting modality. However, modest inequities persist for resource-constrained programs.

Aims: Angina with non-obstructive coronary arteries (ANOCA) is associated with impaired quality of life, and cardiac rehabilitation (CR) may be a promising non-pharmacological treatment option. This scoping review aimed to map how CR for patients with ANOCA is described in the literature, including programme components, delivery characteristics, reported outcomes, and research gaps. Methods and results: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of seven electronic databases was performed from inception to 30 September 2025. Studies reporting CR interventions in adults with ANOCA or related endotypes were included. Data were charted using the Template for Intervention Description and Replication checklist and synthesized descriptively. Qualitative findings were organized using a socio-ecological model. Methodological quality was assessed descriptively using the Mixed Methods Appraisal Tool. The database search yielded 14 072 records, of which 26 studies were included. Cardiac rehabilitation interventions were generally safe and well tolerated, with high adherence rates. Patient-reported outcomes consistently improved, particularly angina symptoms, quality of life, and psychological well-being, while effects on physiological outcomes were heterogeneous. Exercise training was the most common intervention component, often individualized and combined with psychosocial therapies. Qualitative findings highlighted unmet needs related to education, psychological support, validation, and flexible, tailored programme delivery. Substantial variability and methodological limitations were observed across studies. Conclusion: Cardiac rehabilitation for patients with ANOCA appears safe, acceptable, and associated with meaningful improvements in patient-reported outcomes; however, evidence remains fragmented. Standardized, patient-centred CR models and long-term research are needed to optimize care and inform clinical practice for this underserved population. Registration: Open Science Framework: https://osf.io/nt8xe

Aims and objectives: To visualise the health care experiences and needs of patients with ischemia with non‐obstructive coronary arteries in a patient journey map. As such, future design challenges can be provided, and it can be used for future healthcare optimization.Background: Ischemia with non‐obstructive coronary arteries is a chronic cardiac condition caused by vascular dysfunctions. Ischemia with non‐obstructive coronary arteries is often unrecognised, significantly impairs daily functioning, and is more prevalent among women. Patients' experiences remain unexplored, and a clear patient‐centered care pathway is lacking.Design: A qualitative interpretative research design was performed and the standards for reporting qualitative research (SRQR) has been used.Methods: In total, 36 women were included and participated in eight semi‐structured focus group interviews. Thematic analysis was used, and identified themes were further classified using ‘patient journey mapping.’ Additionally, Picker's ‘eight principles of patient‐centered care’ were linked to the results and integrated in the patient journey map.Results: Participants experienced a lack of familiarity with the specific cardiac condition by healthcare providers, repeated hospitalisation, testing and referrals, shortage of specialised cardiologists, and feelings of not being heard. In addition, needs for a multidisciplinary treatment program (including physical and psychological support), better information provision, and an easily accessible contact person were expressed.Conclusions: The resulting patient journey map shows how patients experienced and interacted with the current healthcare system. Overall, the results show a complex and long healthcare pathway and important themes for healthcare experiences and needs were identified. Future research could focus on the development and implementation of a patient‐centered evidence‐based clinical pathway optimising experiences and quality of life.Relevance to clinical practice: The visual tool can help health care professionals, policy makers, and researchers improve healthcare provision which is patient‐centered and tailored to the preferences of patients with ischemia with non‐obstructive coronary arteries.