According to current guidelines comprehensive cardiac rehabilitation (CCR) should be implemented throughout Denmark’s health care system for all patients with heart disease who need it.
Based on results of a postal questionnaire survey from 2000, we found that most hospitals in Denmark offer one or more of the CR components: exercise training, patient education and psychosocial support, smoking cessation and dietary guidance during in-hospital stay and as outpatient hospital services. However, not all hospitals offer comprehensive programmes, defined as hospitals offering all of the above listed components. Community-based maintenance CR services were especially lacking: 57% offered in-hospital CCR; 47% offered outpatient CCR; 36% offered CCR in-hospital and outpatient. According to the heads of departments of cardiology, only two hospitals facilitated access to all components of community-based maintenance CR services. Our survey probably overestimated the coverage of CCR in hospitals in Denmark in 1999 based on comparison with other studies.
Each year an estimated 10,000 to 15,000 patients with IHD and CHF need CCR services in Denmark. To this number should further be added patients undergoing other heart surgery than CABG and patients at high risk of developing IHD discharged from hospitals. It is not known how many of the eligible patients actually participate in CR activities in Denmark, because this information is not registered.
Differences in health care systems and the organization of services do not allow the coverage of CR in Denmark to be directly compared between countries, but based on Denmark’s coverage, Denmark seems to be 5 years or more behind the United Kingdom, Germany and the United States.
We found that Denmark’s health care system made marked progress in implementing CR services in the 1990s; nevertheless, the quantity and quality of services vary widely, and the coverage of services still needs to be expanded considerably. The local implementation study (the DANREHAB trial) showed that outpatient CCR that complies with Denmark’s current guidelines can be organized and implemented at a full scale.
Ensuring full access to CCR services requires initiatives to fully expand these services, which are widely accepted among professionals, politicians and health planners. Several reports and statements have been published in Denmark since 1997; the time has come to prepare practical action plans nationally, regionally and locally. These plans must consider the continuum of CCR, the quality of CCR services, educational needs and future research and development.
Zwisler ADO, Traeden U, Videbaek J et al. Cardiac rehabilitation services in Denmark: still room for expansion. Scand J Public Health. 2005;33(5):376-83. Link to abstract==>>
Zwisler ADO. Cardiac Rehabilitation - Implementation in Denmark and presentation of a local model. PhD dissertation, University of Copenhagen, June 2004. Link to dissertation ==>>
Zwisler ADO, Nissen NK, Madsen M (edt.) [Spreding of cardiac rehabilitation in Denmark from 1969 to 2004] in: [Cardiac rehabilitation - A Health Techonolgy assesment]. National Board of Health in Denmark, Institute of Health Techonology Assesment; In press, 2006. Link to repport when published==>>