Cardiac Rehabilitation Availability and Density around the Globe

Karam Turk-Adawi, Marta Supervia, Francisco Lopez-Jimenez, Ella Pesah, Rongjing Ding, Raquel R. Britto, Birna Bjarnason-Wehrens, Wayne Derman, Ana Abreu, Abraham S. Babu, Claudia Anchique Santos, Seng Khiong Jong, Lucky Cuenza, Tee Joo Yeo, Dawn Scantlebury, Karl Andersen, Graciela Gonzalez, Vojislav Giga, Dusko Vulic, Eleonora VatamanJacqueline Cliff, Evangelia Kouidi, Ilker Yagci, Chul Kim, Briseida Benaim, Eduardo Rivas Estany, Rosalia Fernandez, Basuni Radi, Dan Gaita, Attila Simon, Ssu Yuan Chen, Brendon Roxburgh, Juan Castillo Martin, Lela Maskhulia, Gerard Burdiat, Richard Salmon, Hermes Lomelí, Masoumeh Sadeghi, Eliska Sovova, Arto Hautala, Egle Tamuleviciute-Prasciene, Marco Ambrosetti, Lis Neubeck, Elad Asher, Hareld Kemps, Zbigniew Eysymontt, Stefan Farsky, Jo Hayward, Eva Prescott, Susan Dawkes, Claudio Santibanez, Cecilia Zeballos, Bruno Pavy, Anna Kiessling, Nizal Sarrafzadegan, Carolyn Baer, Randal Thomas, Dayi Hu, Sherry L. Grace

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = .92, 95%CI = .91–.93) or public (OR = .83, 95%CI = .82–84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

Original languageEnglish
Pages (from-to)31-45
Number of pages15
JournalEClinicalMedicine
Volume13
DOIs
Publication statusPublished - 01-08-2019

Fingerprint

Odds Ratio
Confidence Intervals
Myocardial Ischemia
Cardiac Rehabilitation
Linear Models
Cardiovascular Diseases
Incidence
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Turk-Adawi, K., Supervia, M., Lopez-Jimenez, F., Pesah, E., Ding, R., Britto, R. R., ... Grace, S. L. (2019). Cardiac Rehabilitation Availability and Density around the Globe. EClinicalMedicine, 13, 31-45. https://doi.org/10.1016/j.eclinm.2019.06.007
Turk-Adawi, Karam ; Supervia, Marta ; Lopez-Jimenez, Francisco ; Pesah, Ella ; Ding, Rongjing ; Britto, Raquel R. ; Bjarnason-Wehrens, Birna ; Derman, Wayne ; Abreu, Ana ; Babu, Abraham S. ; Santos, Claudia Anchique ; Jong, Seng Khiong ; Cuenza, Lucky ; Yeo, Tee Joo ; Scantlebury, Dawn ; Andersen, Karl ; Gonzalez, Graciela ; Giga, Vojislav ; Vulic, Dusko ; Vataman, Eleonora ; Cliff, Jacqueline ; Kouidi, Evangelia ; Yagci, Ilker ; Kim, Chul ; Benaim, Briseida ; Estany, Eduardo Rivas ; Fernandez, Rosalia ; Radi, Basuni ; Gaita, Dan ; Simon, Attila ; Chen, Ssu Yuan ; Roxburgh, Brendon ; Martin, Juan Castillo ; Maskhulia, Lela ; Burdiat, Gerard ; Salmon, Richard ; Lomelí, Hermes ; Sadeghi, Masoumeh ; Sovova, Eliska ; Hautala, Arto ; Tamuleviciute-Prasciene, Egle ; Ambrosetti, Marco ; Neubeck, Lis ; Asher, Elad ; Kemps, Hareld ; Eysymontt, Zbigniew ; Farsky, Stefan ; Hayward, Jo ; Prescott, Eva ; Dawkes, Susan ; Santibanez, Claudio ; Zeballos, Cecilia ; Pavy, Bruno ; Kiessling, Anna ; Sarrafzadegan, Nizal ; Baer, Carolyn ; Thomas, Randal ; Hu, Dayi ; Grace, Sherry L. / Cardiac Rehabilitation Availability and Density around the Globe. In: EClinicalMedicine. 2019 ; Vol. 13. pp. 31-45.
@article{c60374de61d747c581f2a5020d94dc56,
title = "Cardiac Rehabilitation Availability and Density around the Globe",
abstract = "Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7{\%}) countries; data were collected in 93 (83.8{\%} country response; N = 1082 surveys, 32.1{\%} program response rate). Availability by region ranged from 80.7{\%} of countries in Europe, to 17.0{\%} in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95{\%} confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95{\%}CI = 1.04–1.06), and significantly lower with private (OR = .92, 95{\%}CI = .91–.93) or public (OR = .83, 95{\%}CI = .82–84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.",
author = "Karam Turk-Adawi and Marta Supervia and Francisco Lopez-Jimenez and Ella Pesah and Rongjing Ding and Britto, {Raquel R.} and Birna Bjarnason-Wehrens and Wayne Derman and Ana Abreu and Babu, {Abraham S.} and Santos, {Claudia Anchique} and Jong, {Seng Khiong} and Lucky Cuenza and Yeo, {Tee Joo} and Dawn Scantlebury and Karl Andersen and Graciela Gonzalez and Vojislav Giga and Dusko Vulic and Eleonora Vataman and Jacqueline Cliff and Evangelia Kouidi and Ilker Yagci and Chul Kim and Briseida Benaim and Estany, {Eduardo Rivas} and Rosalia Fernandez and Basuni Radi and Dan Gaita and Attila Simon and Chen, {Ssu Yuan} and Brendon Roxburgh and Martin, {Juan Castillo} and Lela Maskhulia and Gerard Burdiat and Richard Salmon and Hermes Lomel{\'i} and Masoumeh Sadeghi and Eliska Sovova and Arto Hautala and Egle Tamuleviciute-Prasciene and Marco Ambrosetti and Lis Neubeck and Elad Asher and Hareld Kemps and Zbigniew Eysymontt and Stefan Farsky and Jo Hayward and Eva Prescott and Susan Dawkes and Claudio Santibanez and Cecilia Zeballos and Bruno Pavy and Anna Kiessling and Nizal Sarrafzadegan and Carolyn Baer and Randal Thomas and Dayi Hu and Grace, {Sherry L.}",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.eclinm.2019.06.007",
language = "English",
volume = "13",
pages = "31--45",
journal = "EClinicalMedicine",
issn = "2589-5370",
publisher = "Lancet Publishing Group",

}

Turk-Adawi, K, Supervia, M, Lopez-Jimenez, F, Pesah, E, Ding, R, Britto, RR, Bjarnason-Wehrens, B, Derman, W, Abreu, A, Babu, AS, Santos, CA, Jong, SK, Cuenza, L, Yeo, TJ, Scantlebury, D, Andersen, K, Gonzalez, G, Giga, V, Vulic, D, Vataman, E, Cliff, J, Kouidi, E, Yagci, I, Kim, C, Benaim, B, Estany, ER, Fernandez, R, Radi, B, Gaita, D, Simon, A, Chen, SY, Roxburgh, B, Martin, JC, Maskhulia, L, Burdiat, G, Salmon, R, Lomelí, H, Sadeghi, M, Sovova, E, Hautala, A, Tamuleviciute-Prasciene, E, Ambrosetti, M, Neubeck, L, Asher, E, Kemps, H, Eysymontt, Z, Farsky, S, Hayward, J, Prescott, E, Dawkes, S, Santibanez, C, Zeballos, C, Pavy, B, Kiessling, A, Sarrafzadegan, N, Baer, C, Thomas, R, Hu, D & Grace, SL 2019, 'Cardiac Rehabilitation Availability and Density around the Globe', EClinicalMedicine, vol. 13, pp. 31-45. https://doi.org/10.1016/j.eclinm.2019.06.007

Cardiac Rehabilitation Availability and Density around the Globe. / Turk-Adawi, Karam; Supervia, Marta; Lopez-Jimenez, Francisco; Pesah, Ella; Ding, Rongjing; Britto, Raquel R.; Bjarnason-Wehrens, Birna; Derman, Wayne; Abreu, Ana; Babu, Abraham S.; Santos, Claudia Anchique; Jong, Seng Khiong; Cuenza, Lucky; Yeo, Tee Joo; Scantlebury, Dawn; Andersen, Karl; Gonzalez, Graciela; Giga, Vojislav; Vulic, Dusko; Vataman, Eleonora; Cliff, Jacqueline; Kouidi, Evangelia; Yagci, Ilker; Kim, Chul; Benaim, Briseida; Estany, Eduardo Rivas; Fernandez, Rosalia; Radi, Basuni; Gaita, Dan; Simon, Attila; Chen, Ssu Yuan; Roxburgh, Brendon; Martin, Juan Castillo; Maskhulia, Lela; Burdiat, Gerard; Salmon, Richard; Lomelí, Hermes; Sadeghi, Masoumeh; Sovova, Eliska; Hautala, Arto; Tamuleviciute-Prasciene, Egle; Ambrosetti, Marco; Neubeck, Lis; Asher, Elad; Kemps, Hareld; Eysymontt, Zbigniew; Farsky, Stefan; Hayward, Jo; Prescott, Eva; Dawkes, Susan; Santibanez, Claudio; Zeballos, Cecilia; Pavy, Bruno; Kiessling, Anna; Sarrafzadegan, Nizal; Baer, Carolyn; Thomas, Randal; Hu, Dayi; Grace, Sherry L.

In: EClinicalMedicine, Vol. 13, 01.08.2019, p. 31-45.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiac Rehabilitation Availability and Density around the Globe

AU - Turk-Adawi, Karam

AU - Supervia, Marta

AU - Lopez-Jimenez, Francisco

AU - Pesah, Ella

AU - Ding, Rongjing

AU - Britto, Raquel R.

AU - Bjarnason-Wehrens, Birna

AU - Derman, Wayne

AU - Abreu, Ana

AU - Babu, Abraham S.

AU - Santos, Claudia Anchique

AU - Jong, Seng Khiong

AU - Cuenza, Lucky

AU - Yeo, Tee Joo

AU - Scantlebury, Dawn

AU - Andersen, Karl

AU - Gonzalez, Graciela

AU - Giga, Vojislav

AU - Vulic, Dusko

AU - Vataman, Eleonora

AU - Cliff, Jacqueline

AU - Kouidi, Evangelia

AU - Yagci, Ilker

AU - Kim, Chul

AU - Benaim, Briseida

AU - Estany, Eduardo Rivas

AU - Fernandez, Rosalia

AU - Radi, Basuni

AU - Gaita, Dan

AU - Simon, Attila

AU - Chen, Ssu Yuan

AU - Roxburgh, Brendon

AU - Martin, Juan Castillo

AU - Maskhulia, Lela

AU - Burdiat, Gerard

AU - Salmon, Richard

AU - Lomelí, Hermes

AU - Sadeghi, Masoumeh

AU - Sovova, Eliska

AU - Hautala, Arto

AU - Tamuleviciute-Prasciene, Egle

AU - Ambrosetti, Marco

AU - Neubeck, Lis

AU - Asher, Elad

AU - Kemps, Hareld

AU - Eysymontt, Zbigniew

AU - Farsky, Stefan

AU - Hayward, Jo

AU - Prescott, Eva

AU - Dawkes, Susan

AU - Santibanez, Claudio

AU - Zeballos, Cecilia

AU - Pavy, Bruno

AU - Kiessling, Anna

AU - Sarrafzadegan, Nizal

AU - Baer, Carolyn

AU - Thomas, Randal

AU - Hu, Dayi

AU - Grace, Sherry L.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = .92, 95%CI = .91–.93) or public (OR = .83, 95%CI = .82–84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

AB - Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = .92, 95%CI = .91–.93) or public (OR = .83, 95%CI = .82–84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

UR - http://www.scopus.com/inward/record.url?scp=85068157910&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068157910&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2019.06.007

DO - 10.1016/j.eclinm.2019.06.007

M3 - Article

AN - SCOPUS:85068157910

VL - 13

SP - 31

EP - 45

JO - EClinicalMedicine

JF - EClinicalMedicine

SN - 2589-5370

ER -

Turk-Adawi K, Supervia M, Lopez-Jimenez F, Pesah E, Ding R, Britto RR et al. Cardiac Rehabilitation Availability and Density around the Globe. EClinicalMedicine. 2019 Aug 1;13:31-45. https://doi.org/10.1016/j.eclinm.2019.06.007