Cardiac rehabilitation (CR) plays a pivotal role in the comprehensive management of end-stage heart failure (HF), both preceding and following heart transplantation (HTx). However, data elucidating the intersection of CR accessibility and HTx accessibility are scarce.

To investigate the relationship between regional CR activities and HTx rates in France.

Three multivariate linear regression models were constructed to investigate 3 indicators related to HTx: access to listing for HTx rates, HTx annual rates, and 1-year cumulative HTx rates. Data were sourced from the French Biomedicine Agency (RAMS, rapport annuel médical et scientifique) and ScanSanté (ATIH, agence technique de l’information sur l’hospitalisation). RAMS provided annual HTx indicators, while ATIH contributed data on CR activities, categorized into in-hospital (hc) or ambulatory CR (hp), covering all-indication category (CM05) and specific indications for HF (CM0512) and post-organ transplantation (CM27). Regional analyses were conducted based on the pre-2015 territorial configuration of 26 regions. All variables were nationally indexed (IN) to accommodate regional variations.

Across all three models (Figure 1) and Table 1, a dataset comprising 234 observations from the 26 former French regions over the 2014–2022 period was analyzed (26 regions*9 years). Notably, HF on-site rehabilitation (CM0512_hc) demonstrated a significant positive correlation with HTx rates across all models: access to listing for HTx (Model 1: +0.65 [0.33; 0.97], P=0.00008), HTx annual rates (Model 2: +0.66 [0.30; 1.02], P=0.0004), and 1-year cumulative HTx rates (Model 3: +0.49 [0.26; 0.71], P=0.00004). Conversely, the CM05_hc indicator (reflecting access to cardiac rehabilitation for all indications) exhibited an inverse relationship with the three HTx-related indicators across all models: access to listing for HTx (Model 1: -0.33 [-0.69; 0.02], P=0.07), HTx annual rates (Model 2: −0.43 [−0.83; −0.02], P=0.04), and 1-year cumulative HTx rates (Model 3: −0.42 [−0.68; −0.16], P=0.001). Additionally, the presence of regional HTx centers was positively associated with 1-year cumulative HTx rates (Model 3: +0.11 [0.04; 0.19], P=0.004), without significant association with listing for HTx rates (Model 1) and HTx rates (Model 2).

Increased regional HF rehabilitation rates correlate with higher HTx indices. Further studies are needed to delineate CR's impact on pre- and post-HTx outcomes.