Nature of Cardiac Rehabilitation Around the Globe

Abstract

BackgroundCardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.MethodsIn this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.Findings111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05).InterpretationThis first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

“…e visibility and types of CR programs vary across the globe [50]. Depending upon modes of delivery, methods of patient education, accessibility to CR centres with supervised exercise programs, efficacy of cardiac rehabilitation can be predicted.…”

Effectiveness of an Education Intervention Among Cardiac Rehabilitation Patients in Canada: A Multi-Site Study

“…10 Unfortunately, Canada has insufficient capacity to manage all patients with cardiac indications, with one of the reasons being that many CR programs are under-resourced, 14 and thus do not have the capacity to offer comprehensive CR. 15,16 No educational program has been standardized for CR patients in Canada to our knowledge, although patient education is considered a core component of these programs. 6 Our research group has developed and pilot tested an evidence-and theoretically based comprehensive education intervention 17 that incorporates the use of manuals, patient-oriented didactics, online tools, and a small-group format.…”

Cardiac Rehabilitation in India: Results from the International Council of Cardiovascular Prevention and Rehabilitation’s Global Audit of Cardiac Rehabilitation

“…ICCPR, a member of the World Heart Federation, facilitated program identification for this audit. This was a cross-sectional study, details of which have been reported elsewhere [19,20]. In this report, we summarize CR availability and provision in India specifically.…”

“…Characteristics of these programs are shown in Table 1, with elements delivered in Table 2 (note where education sessions were offered, patients were offered on average 4 session, of approximately 25 minutes duration; see supplemental table 2 elsewhere) [24]. Most commonly-accepted indications (see supplemental table 2 elsewhere) [19], most common healthcare professionals on CR teams (supplemental table 3 elsewhere) [19]; cardiopulmonary r esuscitation training are shown in Supplemental Table 5 elsewhere [19]; we note two programs had yoga therapists on staff) and core components delivered (Supplemental Table 6 elsewhere) [19] are also shown by WHO region and in all countries within South-East Asia elsewhere [19], for comparison purposes. In that global paper, the high-quality of CR in India where it does exist is established (Supplementary Table 9 elsewhere) [19].…”