Key result
Cardiac rehabilitation programs in low- and middle-income countries offered significantly fewer core components than those in high-income countries (7.3 vs 7.9 out of 10, p<0.01), with drastically lower national capacity (1 spot per 66 vs 3.4 incident patients).
Why the study?
Cardiac rehabilitation availability, programme characteristics, and barriers were not well known in low- and middle-income countries.
Cross-Sectional (n=1,082)
Yes
Absolute Event Rate: 7.3% vs 7.9%
p-value: p=<0.01
Cardiac rehabilitation is severely under-resourced in low- and middle-income countries, with patients bearing most of the costs, highlighting an urgent need for policy changes to improve access and public funding.
Highlights marked disparities in cardiac rehabilitation by income level; leaves open scalable solutions for LMICs.
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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Pesah et al. (2019) conducted a cross-sectional in Cardiac Rehabilitation (n=1,082). Location in low- and middle-income countries (LMICs) vs. Location in high-income countries (HICs) was evaluated on Number of core components offered (out of 10) (p=<0.01). Cardiac rehabilitation programs in low- and middle-income countries offered significantly fewer core components than those in high-income countries (7.3 vs 7.9 out of 10, p<0.01), with drastically lower national capacity (1 spot per 66 vs 3.4 incident patients).
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