Funding sources and costs to deliver cardiac rehabilitation around the globe: Drivers and barriers

Abstract

Background:Cardiac rehabilitation (CR) reach is minimal globally, primarily due to financial factors. This study characterized CR funding sources, cost to patients to participate, cost to programs to serve patients, and the drivers of these costs. Methods:In this cross-sectional study, an online survey was administered to CR programs globally.Cardiac associations and local champions facilitated program identification. Costs in each country were reported using purchasing power parity (PPP). Results were compared by World Bank country income classification using generalized linear mixed models. Results:111/203 (54.68%) countries in the world offer CR, of which data were collected in 93 (83.78% country response rate; N=1082 surveys, 32.0% program response rate). CR was most-often publicly funded (more in high-income countries [HICs]; p<.001), but in 60.20% of countries patients paid some or all of the cost. Funding source impacted capacity (p=.004), number of patients per exercise session (p<.001), personnel (p=.037), and functional capacity testing (p=.039). The median cost to serve 1 patient was $945.91PPP globally. In low and middleincome countries (LMICs), exercise equipment and stress testing were perceived as the most expensive delivery elements, with front-line personnel costs perceived as costlier in HICs (p=.003). Modifiable factors associated with higher costs included CR team composition (p=.001), stress testing (p=.002) and telemetry monitoring in HICs (p=.01), and not offering alternative models in LMICs (p=.02). Conclusions:Too many patients are paying out-of-pocket for CR, and more public funding is needed. Lowercost delivery approaches are imperative, and include walk tests, task-shifting, and intensity monitoring via perceived exertion.

Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally?

“…As reported elsewhere [12,13], there were 111/203 (54.7%) countries in the world with existent CR programs, of which data were collected in 93 (83.8%). There were 1082 surveys completed (32.1% response rate).…”

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?

“…In 15 (3.3%) programmes, the sole source of funding was the patient ( P < 0.001; data shown by country elsewhere). 44 Table 2 also displays the proportion of the total programme cost patients pay when they are a source of CR financing, and the associated estimated cost to them (purchasing power parity values by country shown elsewhere). 44 Direct cost to patient differed between regions where they paid ( P < 0.05), with the southern region having the highest cost (€809.21).…”

“…44 Table 2 also displays the proportion of the total programme cost patients pay when they are a source of CR financing, and the associated estimated cost to them (purchasing power parity values by country shown elsewhere). 44 Direct cost to patient differed between regions where they paid ( P < 0.05), with the southern region having the highest cost (€809.21). The estimated cost to deliver a full course of CR (as per dose shown in Figure 2) is also shown; cost differed between regions ( P < 0.001), with the western and southern region having the highest cost (€2163 and €3090).…”

Validity and reliability of the turkish version of "cardiac rehabilitation barriers scale"

“…As Iran has similar demographics and culture to Turkey, these findings can also have a repercussion here. But another review has documented that the cost of CR to the patients and the lack of public funding is one of the main reasons why attendance rates are low around the world (13). It is certain that this is not the case in Turkey.…”