Moving cardiac rehabilitation into 21 Danish municipalities halved median travel distance and narrowed geographic and educational gaps in uptake

A register-based cohort study in 21 Danish municipalities, using data from 2013 to 2022, followed 19,080 patients aged 30 or over who were discharged alive after acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting Primary Study (Bihrmann et al., PMID 42873496). It compared uptake of exercise-based cardiac rehabilitation, defined as attending at least once within 180 days of discharge, before and after rehabilitation was decentralised to primary care. Median travel distance to the nearest facility fell from 15.1 km to 7.2 km, and uptake rose by 16% (risk ratio 1.16, 95% confidence interval 1.12–1.19).

The gains were largest where access had been hardest. Among the 20% of patients living furthest away, uptake rose by 45% (risk ratio 1.45, 1.33–1.58), and geographic inequality was significantly reduced. Among patients with a short education, uptake rose by 27% (risk ratio 1.27, 1.20–1.35), and social inequality was significantly reduced. The authors conclude that decentralised delivery looks feasible and equitable, and stress that quality and safety need ongoing monitoring.

Three limits matter. The outcome is uptake, a process measure; the study does not report whether patients were better off clinically. It is a before-and-after comparison within a register cohort, which cannot by itself separate the effect of decentralisation from other changes over the 2013–2022 period. And it concerns cardiac rehabilitation in Denmark, not frailty or any UK service.

Its use for benchmarking is as a design lesson. Where distance and education shape who attends, moving delivery closer narrowed the gap in this setting, and median travel distance fell by about half. It is geographic decentralisation and not remote delivery, so it supports the design principle in the published pattern on remote and virtual care reaching dispersed populations when designed around distance and not that pattern’s claim about remote care itself. Because the outcome is a process measure, it also sits within the published pattern on process measures moving while patient outcomes are flat, untested or unmeasured.