title: National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II).
abstract: OBJECTIVE
  The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation.
  
  
  METHODS
  All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units.
  
  
  RESULTS
  In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%).
  
  
  CONCLUSIONS
  CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses.
authors.affiliation: Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico. Electronic address: hermes_ilarraza@yahoo.com.
authors.forename: Hermes
authors.initials: H
authors.lastname: Ilarraza-Lomelí
authors.affiliation: Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico.
authors.forename: Marianna
authors.initials: M
authors.lastname: García-Saldivia
authors.affiliation: Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico.
authors.forename: Jessica
authors.initials: J
authors.lastname: Rojano-Castillo
authors.affiliation: Programa Nacional de Rehabilitación Cardiaca, IMSS, Mexico.
authors.forename: Samuel
authors.initials: S
authors.lastname: Justiniano
authors.affiliation: Rehabilitación Cardiaca, Centro Recovery (Puebla, Pue.), Mexico.
authors.forename: Norma
authors.initials: N
authors.lastname: Cerón
authors.affiliation: Rehabilitación Cardiaca, Cárdica (Cuernavaca, Mor.), Mexico.
authors.forename: Zulema-L
authors.initials: ZL
authors.lastname: Aranda-Ayala
authors.affiliation: Rehabilitación Cardiaca, Hospital General Naval de Alta Especialidad, Mexico.
authors.forename: Azucena
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Rehabilitación Cardiaca, Instituto Cardiovascular de Saltillo (Saltillo, Coah.), Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hernández
authors.affiliation: Centro de Rehabilitación Cardiopulmonar, Clínica Lomas Altas, Mexico.
authors.forename: María-Elena
authors.initials: ME
authors.lastname: Cassaigne
authors.affiliation: Rehabilitación Cardiaca, Hospital de Cardiología CMN Siglo XXI-IMSS, Mexico.
authors.forename: Raúl
authors.initials: R
authors.lastname: Cantero
authors.affiliation: Rehabilitación Cardiaca, Unidad de Medicina Física y Rehabilitación Centro-IMSS, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Gasca
authors.affiliation: Rehabilitación Cardiaca, Hospital Civil de Guadalajara Dr. Juan I Menchaca (Guadalajara Jal.), Mexico.
authors.forename: Tania
authors.initials: T
authors.lastname: Hinojosa
authors.affiliation: Rehabilitación Cardiaca, Hospital Bernardette (Guadalajara, Jal.), Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Rehabilitación Cardiaca del Centro (León Gto.), Mexico.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Romo
authors.affiliation: Rehabilitación Cardiaca, CARDIOFIT, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lara
authors.affiliation: Rehabilitación Cardiaca, Centro Médico "20 de Noviembre"-ISSSTE, Mexico.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pimentel
authors.affiliation: Rehabilitación Cardiaca, Instituto Nacional de Rehabilitación, Mexico.
authors.forename: Juana
authors.initials: J
authors.lastname: Zavala
authors.affiliation: Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico.
authors.forename: María-Dolores
authors.initials: MD
authors.lastname: Rius-Suárez
authors.affiliation: Fisiología Cardiovascular, RHC y Medicina del Deporte, Hospital Ángeles Pedregal, Mexico.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cherebetiu
authors.affiliation: Rehabilitación Cardiaca, Unidad de Medicina Física y Rehabilitación Norte-IMSS, Mexico.
authors.forename: Othniel
authors.initials: O
authors.lastname: Cortés
authors.affiliation: Centro de Rehabilitación Cardiaca, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Almaraz
authors.affiliation: Rehabilitación Cardiaca, Médica Sur, Mexico.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mendoza
authors.affiliation: Clínica Médica de Alta Especialidad, Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Silva
authors.affiliation: Rehabilitación Cardiaca, Hospital Tec 100, Mexico.
authors.forename: Enrique
authors.initials: E
authors.lastname: Tirado
authors.affiliation: Rehabilitación Cardiaca, PEMEX-Picacho, Mexico.
authors.forename: Leonel
authors.initials: L
authors.lastname: Martínez
mesh_terms: D000072038:Cardiac Rehabilitation; D006801:Humans; D008800:Mexico; D012042:Registries
keywords: Cardiac rehabilitation; Ejercicio; Exercise; Heart failure; Infarto del miocardio; Insuficiencia cardiaca; Mexico; Myocardial infarction; México; Prevención; Prevention; Rehabilitación cardiaca