Cardiac Rehabilitation Dose Around the World

Abstract

Background: Cardiac rehabilitation (CR) is recommended in clinical practice guidelines, but dose prescribed varies highly by country. This study characterized the dose offered in supervised CR programs and alternative models worldwide and their potential correlates. Methods and Results: In this cross-sectional study, an online survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Countries were classified based on region and income categories. Dose was operationalized as program duration×sessions per week. Generalized linear mixed models were performed to assess correlates. Of 203 countries in the world, 111 (54.7%) offered CR; data were collected in 93 (83.8% country response rate; n=1082 surveys, 32.1% program response rate). Globally, supervised CR programs were a median of 24 sessions (n=619, 57.3% programs ≥12 sessions); home-based and community-based programs offered 6 and 20 sessions, respectively. There was significant variation in supervised CR dose by region ( P ≤0.001), with the Americas (median, 36 sessions) offering a significantly greater dose than several other regions; there was also a trend for variation by country income classification. There was no difference in home-based dose by region ( P =0.43) but there was for community-based programs ( P <0.05; Americas offering greater dose). There was a significant dose variation in both home- and community-based programs by income classification ( P =0.002 and P <0.001, respectively), with higher doses offered by upper-middle-income than high-income countries. Correlates of supervised CR dose included more involvement of physicians ( P =0.026), proximity to other programs ( P =0.002), and accepting patients with noncardiac indications ( P =0.037). Conclusions: CR programs in many countries may need to increase their dose, which could be supported through physician champions.

Nature of Cardiac Rehabilitation Around the Globe

“…Initial assessment (likely a reflection of inclusion criteria), risk factor management and patient education were the most frequently-delivered (Table 3; country-level data for key components shown in Supplemental Table 6), and on average, patients received 8.5 ± 10.8 (median = 6) education sessions per program, with each session lasting 47.0 ± 29.7 (median = 45) minutes (further detail elsewhere [35]; also regarding dose of exercise [37]). The median number of core components offered by programs was 8.7 (Q25-Q75 = 8.0–10.0).…”

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

“…Cardiac rehabilitation (CR) is recommended as the standard of care for secondary prevention of CVD [ 7 8 ] as it significantly reduces morbidity and mortality [ 9 ]. Although models vary, CR is generally delivered in clinical settings [ 10 ], involving generally bi-weekly visits for exercise, education and counselling sessions over several months, for a median of 24 sessions globally [ 11 ]. These in-person visits therefore, if continued during COVID-19, carry a high risk of exposure.…”

Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study

“…Indeed, based on evidence of effectiveness [ [9] , [10] , [11] ], patient education is also a CR quality indicator [ 12 ]. In most Latin American countries however, patient education is not often delivered, and definitely not in a standardized way where it is [ 13 ]. This is despite our recent randomized controlled trial demonstrating it can be delivered in this region, and is effective [ 14 ].…”