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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac rehabilitation delivery in low/middle-income countries
Ella Pesah1, Karam Turk-Adawi2, Marta Supervia3,4
1School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
Insights
Cardiac rehabilitation (CR) is available in only 40% of low- and middle-income countries (LMICs), with patients often bearing the cost. Governments should implement policies to fund CR services for better accessibility.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) availability and characteristics are poorly understood in low- and middle-income countries (LMICs).
- Understanding these factors is crucial for improving cardiovascular disease (CVD) care globally.
Purpose of the Study:
- To compare CR availability, program features, and funding in LMICs versus high-income countries (HICs).
- To identify barriers and facilitators for CR implementation in diverse healthcare settings.
Main Methods:
- A global cross-sectional online survey of CR programs.
- Calculation of CR need based on incident ischemic heart disease (IHD) estimates.
- Analysis using general linear mixed models.
Main Results:
- CR is available in 39.9% of LMICs, with one spot per 66 IHD patients (vs. 3.4 in HICs).
- Patients predominantly fund CR in LMICs (65.0%), contrasting with government funding in HICs (60.2%).
- CR programs in LMICs offer core components consistent with guidelines, with publicly funded programs providing more comprehensive services.
Conclusions:
- CR availability remains limited in LMICs, despite programs adhering to guidelines.
- Governmental policies and reimbursement are essential to alleviate patient out-of-pocket expenses for CR.
- Addressing funding disparities is key to expanding access to CR globally.
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.
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