Cardiac Rehabilitation Availability and Density around the Globe

Abstract

BackgroundDespite 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.MethodsA 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.FindingsCR 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.InterpretationCR 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.

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

“…54 Similarly, global access to cardiac rehabilitation is poor, with cardiac rehabilitation only available in approximately half of the countries, globally. 55 Methods of funding included public, private and hybrid funding, all varying by country, with financial constraints the greatest barrier to cardiac rehabilitation, globally. 55 Lack of funding for PH programs, particularly in the outpatient setting, was noted in the present study and by Keen et al 50 This reflects the current funding climate in Australia and overseas, 40 where a large proportion of health resources are directed towards the acute care (inpatient) setting.…”

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.…”

“…Almost half of countries in the world do not have CR. Despite the availability of CR in India (given the high burden of CVD), the unmet need for CR is highest in India of any country in the world [19,20,23]. The programs that are available were clustered in the southern states of India, leaving major gaps in services in the North, East and West.…”

“…Caution is warranted in interpreting these results, with limitations for the global study elucidated elsewhere [19,20]. Given the sampling method, lack of a CR association and registry in India, there may be ascertainment bias.…”

“…No programs offered community-based CR; and only one (5.6%) program reported alternative models were reimbursed (See supplemental Table 1 elsewhere) [24]. Finally, researched rated perceived barriers to delivery, and programs in India most strongly endorsing lack of patient referral followed by financial resources [20].…”