New Frontiers in Cardiac Rehabilitation: Remote Delivery and Wearable Monitoring to Close a Global Participation Gap

Cardiac rehabilitation reduces myocardial infarction and hospitalization after acute coronary syndromes, coronary revascularization, and heart failure, yet it remains one of the most underused therapies in cardiovascular medicine worldwide. Only about half of the world's countries offer any cardiac rehabilitation, global program capacity is sufficient for roughly one in every twelve eligible patients, and participation among eligible patients rarely exceeds one third in high-income countries and is far lower in low- and middle-income countries. Because distance, transportation, work obligations, and program capacity are the dominant barriers, remote delivery has emerged as the most scalable response. The aim of this narrative review is to critically appraise two closely related approaches to closing this participation gap: home-based, hybrid, and telehealth-delivered cardiac rehabilitation, and wearable and connected-device monitoring that extends clinician oversight into the home. Randomized trials and meta-analyses from North America, Europe, Australasia, and Asia indicate that home-based and telehealth-delivered programs produce gains in exercise capacity, quality of life, and risk-factor control similar to those of center-based programs, with comparable safety and frequently higher completion. Wearable sensors reliably capture heart rate, rhythm, and activity and can increase physical activity, but evidence that continuous monitoring improves hard outcomes in rehabilitation populations is limited. Newer exercise prescriptions, immersive technologies, and connected exercise devices are promising when delivered through these platforms, although their cardiac-specific evidence remains early. Reimbursement, data interoperability, digital literacy, and safety escalation pathways, all of which differ substantially between health systems, are the principal barriers to adoption. Technology-enabled rehabilitation should be integrated within the established core components of cardiac rehabilitation and evaluated in diverse populations, including those in low-resource settings.