Cardiac rehabilitation programme accreditation and certification: Comparing international practices, mapping standards, benchmarks, and future directions - A scoping review.

Abstract

Aims: Programme accreditation and certification are key mechanisms for standardising, assuring, and continuously improving the quality of cardiac rehabilitation. Comparative evidence on existing accreditation and certification schemes remains limited. This review compared these schemes to identify key characteristics, standards, convergences, divergences, implementation, and gaps to inform future quality improvement directions.

Methods: A scoping review following PRISMA-ScR guidelines was conducted searching four databases, grey literature and accreditation bodies' websites (August-September 2025). Cardiac rehabilitation certification schemes with publicly accessible descriptive or evaluative documentation were included. Extracted data were analysed narratively.

Results: Eleven peer-reviewed studies and 38 organisational documents met the inclusion criteria. Four schemes from USA, United Kingdom, Europe, and the International Council of Cardiovascular Prevention and Rehabilitation were included in the comparative analysis because sufficient public documentation was available. Certification standards were mapped across schemes, consolidated into 18 and classified according to Donabedian domains. Thirteen standards were universal (endorsed by all four schemes) or near-universal (endorsed by three) including multidisciplinary care, assessments, exercise, education, and counselling; however, their operationalisation varies. Certification uptake was concentrated in high-income settings. Reported barriers were related to resources, cost, and infrastructure. Evidence of certification impact was limited.

Conclusion: Shared standards suggest broad consensus on the core components of high-quality cardiac rehabilitation. Resource, cost, and infrastructure barriers may influence certification accessibility and adoption. Leveraging shared standards while allowing flexible implementation pathways may support broader uptake of quality-assured cardiac rehabilitation. Further rigorous evaluation is needed to determine whether certification translates into sustained improvements in service quality and meaningful health gains.