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. 2019 Jul 3:13:31-45.
doi: 10.1016/j.eclinm.2019.06.007. eCollection 2019 Aug.

Cardiac Rehabilitation Availability and Density around the Globe

Karam Turk-Adawi  1 , Marta Supervia  2   3 , Francisco Lopez-Jimenez  3 , Ella Pesah  4 , Rongjing Ding  5 , Raquel R Britto  6 , Birna Bjarnason-Wehrens  7 , Wayne Derman  8 , Ana Abreu  9 , Abraham S Babu  10 , Claudia Anchique Santos  11 , Seng Khiong Jong  12 , Lucky Cuenza  13 , Tee Joo Yeo  14 , Dawn Scantlebury  15 , Karl Andersen  16 , Graciela Gonzalez  17 , Vojislav Giga  18 , Dusko Vulic  19 , Eleonora Vataman  20 , Jacqueline Cliff  21 , Evangelia Kouidi  22 , Ilker Yagci  23 , Chul Kim  24 , Briseida Benaim  25 , Eduardo Rivas Estany  26 , Rosalia Fernandez  27 , Basuni Radi  28 , Dan Gaita  29 , Attila Simon  30 , Ssu-Yuan Chen  31 , Brendon Roxburgh  32 , Juan Castillo Martin  33 , Lela Maskhulia  34 , Gerard Burdiat  35 , Richard Salmon  36 , Hermes Lomelí  37 , Masoumeh Sadeghi  38 , Eliska Sovova  39 , Arto Hautala  40 , Egle Tamuleviciute-Prasciene  41 , Marco Ambrosetti  42 , Lis Neubeck  43 , Elad Asher  44 , Hareld Kemps  45 , Zbigniew Eysymontt  46 , Stefan Farsky  47 , Jo Hayward  48 , Eva Prescott  49 , Susan Dawkes  43 , Claudio Santibanez  50 , Cecilia Zeballos  51 , Bruno Pavy  52 , Anna Kiessling  53 , Nizal Sarrafzadegan  38   54 , Carolyn Baer  55 , Randal Thomas  3 , Dayi Hu  56 , Sherry L Grace  4   57
Affiliations

Cardiac Rehabilitation Availability and Density around the Globe

Karam Turk-Adawi et al. EClinicalMedicine. .

Abstract

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.

Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.

Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.

Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

Keywords: Capacity; Cardiac rehabilitation; Density; Global health; Health services; Preventive cardiology.

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Conflict of interest statement

Dr. Derman reports some financial activities that were outside the submitted work (i.e., grants from International Olympic and Paralympic Committees, as well as personal fees from 2 advisory boards). All other authors declare no financial or personal interests.

Figures

Fig. 1
Fig. 1
Global availability of cardiac rehabilitation, by age-standardized ischemic heart disease incidence tertile (2016). Source of incidence estimates: Global Burden of Disease Study IHD, ischemic heart disease; CR, cardiac rehabilitation.
Fig. 2
Fig. 2
Total number of cardiac rehabilitation programs per country.
Fig. 3
Fig. 3
Ischemic heart disease incidence by number of cardiac rehabilitation programs in a country. IHD, ischemic heart disease; CR, cardiac rehabilitation.
See this image and copyright information in PMC

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