Cardiac Rehabilitation in Patients with Coronary Heart Disease—Challenges, Inequalities, and Opportunities for Global Health
Bibliographic record
Abstract
Cardiac rehabilitation (CR) is a cornerstone of secondary prevention in coronary heart disease, supported by robust evidence and classified as a Class I recommendation in international guidelines. Despite its proven benefits in reducing morbidity, mortality, and improving quality of life, CR remains strikingly underutilized worldwide, revealing a paradox of high-level evidence with low-level implementation. The INTERASPIRE study highlights this global gap, showing that many patients are neither referred nor adhere to CR programs, and that profound inequities persist across regions and socioeconomic groups. These findings underscore systemic failures in translating guideline recommendations into practice, driven not only by structural limitations but also by physician referral patterns, patient awareness, and health system priorities. Addressing this gap requires investment in infrastructure, equitable referral strategies, standardization of program content, and innovative delivery models such as telehealth. Ensuring universal access to CR is both a clinical imperative and a matter of health equity, with the potential to transform outcomes for patients with cardiovascular disease worldwide.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".