Cardiac rehabilitation delivery in low/middle-income countries

Objective Cardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source. Methods A cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed. Results CR was identified in 55/138 (39.9%) LMICs; 47/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; p<0.001). Over 85% of programmes accepted guideline-indicated patients. Cardiologists (n=266, 89.3%), nurses (n=234, 79.6%; vs 544, 91.7% in HICs, p=0.001) and physiotherapists (n=233, 78.7%) were the most common providers on CR teams (mean=5.8±2.8/programme). Programmes offered 7.3±1.8/10 core components (vs 7.9±1.7 in HICs, p<0.01) over 33.7±30.7 sessions (significantly greater in publicly funded programmes; p<0.001). Publicly funded programmes were more likely to have social workers and psychologists on staff, and to offer tobacco cessation and psychosocial counselling. Conclusion CR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.

[1]  S. Grace,et al.  Funding sources and costs to deliver cardiac rehabilitation around the globe: Drivers and barriers. , 2019, International journal of cardiology.

[2]  L. Neubeck,et al.  Cardiac Rehabilitation Availability and Density around the Globe☆ , 2019, EClinicalMedicine.

[3]  Graciela Gonzalez,et al.  AVAILABILITY AND QUALITY OF CARDIAC REHABILITATION AROUND THE GLOBE: PATIENTS SERVED, PROVIDERS, AND CORE COMPONENTS , 2018 .

[4]  P. Mendoza,et al.  National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II). , 2017, Archivos de cardiologia de Mexico.

[5]  S. Grace,et al.  A Review of Cardiac Rehabilitation Delivery Around the World. , 2017, Progress in cardiovascular diseases.

[6]  Alan D. Lopez,et al.  Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015 , 2017, Journal of the American College of Cardiology.

[7]  V. Fuster,et al.  Availability, Use, and Barriers to Cardiac Rehabilitation in LMIC. , 2017, Global heart.

[8]  F. Lopez‐Jimenez,et al.  Advocacy for outpatient cardiac rehabilitation globally , 2016, BMC Health Services Research.

[9]  F. Lopez‐Jimenez,et al.  Availability and characteristics of cardiac rehabilitation programmes in China , 2016, Heart Asia.

[10]  H. Ilárraza-Lomelí,et al.  PS091 National Registry of Cardiac Rehabilitation Programs in Mexico Ii (Renaprec Ii) , 2016 .

[11]  N. Sarrafzadegan,et al.  Cardiac rehabilitation delivery model for low-resource settings , 2016, Heart.

[12]  Rod S Taylor,et al.  Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. , 2016, Journal of the American College of Cardiology.

[13]  Sherry L. Grace,et al.  Cardiac rehabilitation in Canada and Arab countries: comparing availability and program characteristics , 2015, BMC Health Services Research.

[14]  N. Sarrafzadegan,et al.  Global availability of cardiac rehabilitation , 2014, Nature Reviews Cardiology.

[15]  M. Drazner,et al.  2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.

[16]  F. Lopez‐Jimenez,et al.  Availability and Characteristics of Cardiovascular Rehabilitation Programs in South America , 2013, Journal of Cardiopulmonary Rehabilitation and Prevention.

[17]  苅尾 七臣,et al.  ガイドライン解説 AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease : 2011 update , 2012 .

[18]  S. Grace,et al.  Cardiac rehabilitation services in Ontario: components, models and underserved groups , 2012, Journal of cardiovascular medicine.

[19]  G. Levine,et al.  2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. , 2011, Journal of the American College of Cardiology.

[20]  V. Chair,et al.  ACCF/AHA Practice Guideline 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines , 2011 .

[21]  John Spertus,et al.  AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. , 2011, Circulation.

[22]  S. Ebrahim,et al.  Exercise-based cardiac rehabilitation for coronary heart disease. , 2016, The Cochrane database of systematic reviews.

[23]  H. McGee,et al.  Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey , 2010, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[24]  F. Sert-Kuniyoshi,et al.  Current status of cardiac rehabilitation in Latin America and the Caribbean. , 2009, American heart journal.

[25]  J. Ornato,et al.  ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). , 2004, Circulation.

[26]  B. Norrving,et al.  Global atlas on cardiovascular disease prevention and control. , 2011 .

[27]  A. Alwan Global status report on noncommunicable diseases 2010. , 2011 .

[28]  N. P. Napalkov,et al.  for the prevention and control of noncommunicable diseases , 1999 .