Over half of heart attack survivors are failing to avail of a potentially life-saving service, a leading charity has said.
New figures from the British Heart Foundation Northern Ireland (BHF NI) show that just 39% of patients accessed cardiac rehabilitation after a heart attack or procedure, representing a decrease of 2% since last year.
It means over 3,440 patients are missing out on the service, putting them at risk of suffering another heart attack, according to the National Audit of Cardiac Rehabilitation (NACR) report.
Cardiac rehabilitation is a vital service for people after a heart attack, coronary angioplasty and heart surgery, the charity said. It is also important for patients with angina or heart failure.
Programmes aim to help patients understand their condition and recover from surgery by providing lifestyle advice to improve physical and psychological health - such as advice on eating healthily and exercise.
Karen McCammon from BHF NI said that it's "worrying that an increased number of heart attack patients here are still missing out on this effective service".
"Cardiac rehabilitation services across Northern Ireland are led by dedicated staff who can help heart patients regain their physical and emotional health after a cardiac event," she said.
"It is vital all patients are accessing this important service, however, we have been encouraged by the increased investment in cardiac rehab services in Northern Ireland this year."
She also said the Western Trust secured £500,000 for a new cardiac rehab programme called MyAction, to run right across the Western Trust area.
"It focuses on healthy lifestyle change such as smoking cessation, healthy diet and weight, and physical activity and is a fantastic example of best practice in cardiac rehab," she added.
The NACR report shows a marked difference in the number of men and women accessing rehab services, with women much less likely to attend. And, even if they are attending cardiac rehab, women are not reaping the same benefits as male patients.
They are less likely to improve their physical fitness and meet target levels for cholesterol and alcohol intake following rehab, according to the report.
The charity said this is, in part, because programmes historically offer group-based rehab in a community setting which is less appealing to women.
Patrick Doherty, professor of cardiovascular health at York University and lead author for the NACR, said cardiac rehabilitation "can be the difference between life and death".
"These figures should be of concern to all heart patients, regardless of gender," he said.
"It could be the difference between your wife, mother, sister or daughter living a fulfilled life or struggling from the after-effects of a heart attack.
"It's clear that cardiac rehabilitation is a highly effective intervention but we need to ensure it works for everyone."
Evidence from clinical trials suggests that cardiac rehab can be delivered successfully through digital or home-based programmes.
BHF NI believes that offering such a solution will increase the number of people entering cardiac rehab over the next few years. The charity said it will increase uptake among under-represented groups such as women and people from deprived and ethnic minority backgrounds.
The estimated number of cardiac patients who are missing out on the rehabilitation service