Description
Before 2017, cardiac rehabilitation (CR) in Slovenia was under-utilised and limited mainly to short-term residential programmes. To expand CR content and provision, key stakeholders (including the Slovenian Society of Cardiology, the Health Insurance Institute of Slovenia, the National Institute of Public Health, and the Slovenian Forum for Cardiovascular Disease Prevention) proposed the set-up of comprehensive outpatient CR centres affiliated with each regional hospital in the country. Until now, seven regional centres were established to provide comprehensive multidisciplinary outpatient CR. Comprehensive outpatient cardiac rehabilitation (CR) programmes provide CR over a 3-month period, comprising: i) intake visit with comprehensive cardiovascular assessment (including initial exercise testing and laboratory analyses), ii) 36 exercise training sessions under physical/exercise therapist supervision, iii) risk factor management (including specialist blood pressure, lipids and diabetes management, and access to smoking cessation and weight management programmes), iv) secondary preventive medication management and monitoring (under cardiologist supervision), v) nurse-led patient education, nutritional counselling and health promotion (three group sessions and individual counselling as needed), vi) screening for mood disorders (with priority access to mental health consultation), and vii) final assessment (including exercise testing, laboratory analysis, echocardiography, and structured transition to long-time care, including referral to "phase III" community programmes). Exercise sessions are 2-3 times per week, featuring 60 minutes of moderate aerobic and low-intensity resistance training.Program launch date
Hospital-affiliated centre-based outpatient CR programmes began in January 2017, including facility set-up, personnel training, and referral pathways for myocardial infarction patients, recommending CR intake within 30 days post-discharge. Setup finished in 6 months under the Centre for Preventive Cardiology, University Medical Centre Ljubljana.Responsible entity
National Health Fund. Program set-up reimbursement covered cardiology supervision, nurse-led lifestyle intervention, exercise sessions, intake, exercise testing, lab analyses, echocardiography, and necessary referrals (e.g., psychologist, occupational consultations). Full reimbursement required completing 36 sessions, exclusive of residential short-term CR participation.Available results and quality metrics
Establishing dedicated regional comprehensive outpatient centers enhances CR uptake post-myocardial infarction. The proportion of patients participating in CR increased from 25% before the introduction of comprehensive outpatient CR programmes in 2016 to 40% by 2020. Participation in outpatient or short-term residential CR leads to a 42% and 21% reduction in death and cardiovascular hospitalizations, respectively, with mortality decreasing by 46% and 41%. A five-year interim analysis (2017 -- 2021) indicates outpatient CR is more effective in reducing cardiovascular hospitalizations.Limitations / comments
Until now, seven regional centres providing comprehensive outpatient CR were established in Slovenia, while the aim is to assure these services nationwide. The participation rate of post-MI patients should be increased. The data on performance and quality indicators are collected within the National CR Registry. It is our plan to assure the completeness of data by joining the EuroHeart Registry platform in the near future.