Cardiac rehabilitation delivery in low/middle-income countries

Ella Pesah, Karam Turk-Adawi, Marta Supervia, Francisco Lopez-Jimenez, Raquel Britto, Rongjing Ding, Abraham Babu, Masoumeh Sadeghi, Nizal Sarrafzadegan, Lucky Cuenza, Claudia Anchique Santos, Martin Heine, Wayne Derman, Paul Oh, Sherry L Grace

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Abstract

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.

Original languageEnglish
JournalHeart
DOIs
Publication statusE-pub ahead of print - 28-06-2019

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Myocardial Ischemia
Cardiac Rehabilitation
Guidelines
Tobacco Use Cessation
Physical Therapists
Counseling
Linear Models
Cross-Sectional Studies
Nurses
Psychology
Global Burden of Disease
Cardiologists
Surveys and Questionnaires
Social Workers

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Pesah, E., Turk-Adawi, K., Supervia, M., Lopez-Jimenez, F., Britto, R., Ding, R., ... Grace, S. L. (2019). Cardiac rehabilitation delivery in low/middle-income countries. Heart. https://doi.org/10.1136/heartjnl-2018-314486
Pesah, Ella ; Turk-Adawi, Karam ; Supervia, Marta ; Lopez-Jimenez, Francisco ; Britto, Raquel ; Ding, Rongjing ; Babu, Abraham ; Sadeghi, Masoumeh ; Sarrafzadegan, Nizal ; Cuenza, Lucky ; Anchique Santos, Claudia ; Heine, Martin ; Derman, Wayne ; Oh, Paul ; Grace, Sherry L. / Cardiac rehabilitation delivery in low/middle-income countries. In: Heart. 2019.
@article{7e3d7fc38262471483199ebb5da84cd5,
title = "Cardiac rehabilitation delivery in low/middle-income countries",
abstract = "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.",
author = "Ella Pesah and Karam Turk-Adawi and Marta Supervia and Francisco Lopez-Jimenez and Raquel Britto and Rongjing Ding and Abraham Babu and Masoumeh Sadeghi and Nizal Sarrafzadegan and Lucky Cuenza and {Anchique Santos}, Claudia and Martin Heine and Wayne Derman and Paul Oh and Grace, {Sherry L}",
note = "{\circledC} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
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Pesah, E, Turk-Adawi, K, Supervia, M, Lopez-Jimenez, F, Britto, R, Ding, R, Babu, A, Sadeghi, M, Sarrafzadegan, N, Cuenza, L, Anchique Santos, C, Heine, M, Derman, W, Oh, P & Grace, SL 2019, 'Cardiac rehabilitation delivery in low/middle-income countries', Heart. https://doi.org/10.1136/heartjnl-2018-314486

Cardiac rehabilitation delivery in low/middle-income countries. / Pesah, Ella; Turk-Adawi, Karam; Supervia, Marta; Lopez-Jimenez, Francisco; Britto, Raquel; Ding, Rongjing; Babu, Abraham; Sadeghi, Masoumeh; Sarrafzadegan, Nizal; Cuenza, Lucky; Anchique Santos, Claudia; Heine, Martin; Derman, Wayne; Oh, Paul; Grace, Sherry L.

In: Heart, 28.06.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiac rehabilitation delivery in low/middle-income countries

AU - Pesah, Ella

AU - Turk-Adawi, Karam

AU - Supervia, Marta

AU - Lopez-Jimenez, Francisco

AU - Britto, Raquel

AU - Ding, Rongjing

AU - Babu, Abraham

AU - Sadeghi, Masoumeh

AU - Sarrafzadegan, Nizal

AU - Cuenza, Lucky

AU - Anchique Santos, Claudia

AU - Heine, Martin

AU - Derman, Wayne

AU - Oh, Paul

AU - Grace, Sherry L

N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/6/28

Y1 - 2019/6/28

N2 - 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.

AB - 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.

U2 - 10.1136/heartjnl-2018-314486

DO - 10.1136/heartjnl-2018-314486

M3 - Article

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JO - Heart

JF - Heart

SN - 1355-6037

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Pesah E, Turk-Adawi K, Supervia M, Lopez-Jimenez F, Britto R, Ding R et al. Cardiac rehabilitation delivery in low/middle-income countries. Heart. 2019 Jun 28. https://doi.org/10.1136/heartjnl-2018-314486