Effects of Cardiac Rehabilitation in Low- and Middle-Income Countries: A systematic Review and Meta-Analysis of Randomised Controlled Trials

Mamataz, Taslima; Uddin, Jamal; Alam, Sayed Ibn; Taylor, Rod S; Pakosh, Maureen; Grace, Sherry L.

doi:10.1016/j.pcad.2021.07.004

Cited by 32 publications

(23 citation statements)

References 65 publications

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“…Second, there is some retention bias in the sample. Third, due to the nature of the design, causal conclusions cannot be drawn; however, these results are in line with the few randomized trials on CR in countries of the EMR [10] and hence it is likely the effects are robust. Indeed, there was no control group, and in future evaluation it will be important to incorporate such a comparison arm.…”

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confidence: 61%

Evaluation of Qatar’s First Cardiac Rehabilitation Program: A Brief Report

Faisal

Saad

Alhashemi

et al. 2021

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Background: There are few studies on the impact of cardiac rehabilitation (CR) in the Eastern Mediterranean Region (EMR), where the burden of risk factors and context is somewhat different from Western countries where much of the evidence is derived. Objective: To evaluate patient engagement in, and outcomes associated with, participation in Qatar's first and only CR program, from inception. Methods: This was a retrospective, observational study of patients referred to Heart Hospital's CR program from January 2013-September, 2018. The program offered 3 sessions/week over 6-12 weeks, depending on patient risk. An initial assessment was performed, and outcomes (i.e., functional capacity, risk factors, and psychosocial well-being (quality of life [SF-36] and depressive symptoms) were re-assessed post-program in those who did not drop-out. Session attendance was recorded. Results: 682 patients enrolled; they attended 77.6% of prescribed sessions; 554 (81.2%) completed the program and post-assessment. Improvements in functional capacity were statistically and clinically meaningful (METs 9.3 ± 3.3 pre and 11.1 ± 3.7 post; p < 0.001). There were significant improvements in body mass index (28.7 ± 5.2 kg/m 2 pre and 28.2 ± 5.4 post; p < 0.001), waist circumference (102.8 ± 13.0 cm pre and 101.8 ± 13.2 post; p < 0.001), low-density lipoprotein (LDL 1.9 ± 0.9 mmol/L pre and 1.6 ± 0.8 post; p = < 0.001), total cholesterol (3.6 ± 1.1 mmol/L pre and 3.3 ± 0.8 post; p < 0.001), systolic blood pressure (SBP 128.5 ± 17.7 mmHg pre and 123.7 ± 14.8 post; p < 0.001), hemoglobin A1c (6.8 ± 1.6% pre and 6.5 ± 1.3 post; p < 0.001) and depressive symptoms (Cardiac Depression Scale score 78.3 ± 23.9 pre and 66.3 ± 21.3 post; p < 0.001). Improvements on 7 of the 8 quality of life domains were also observed (all p < .05; e.g., physical functioning 68.2 ± 24.0 pre and 74.9 ± 24.4 post). Conclusion:The new Qatari CR program is very engaging to patients, and resulted in clinically significant risk factors (LDL, SBP, and cholesterol) as well as functional capacity and healthrelated quality of life improvements, which likely translate to reduced morbidity and mortality.

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confidence: 61%

Evaluation of Qatar’s First Cardiac Rehabilitation Program: A Brief Report

Faisal

Saad

Alhashemi

et al. 2021

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“…CR programs have been widely recommended as an adjuvant in the treatment of numerous cardiovascular diseases, including CCC [22][23][24]. In a pioneer study, Lima et al [10] conducted a randomised clinical trial aiming to evaluate the effects of a physical exercise program in 40 patients with CCC.…”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of an exercise‐based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

Simões

Mendes

Avellar

et al. 2022

Tropical Med Int Health

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Objectives: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). Methods: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO 2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by β coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). Results: The intervention group presented higher costs with healthcare visits (β = +3317.3; p < 0.001), hospitalisation (β = +2810.4; p = 0.02) and total cost (β = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (β = +2455.8; p < 0.001) and total cost (β = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg À1 min À1 of VO 2peak . Conclusions: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

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“…Indeed, participation results in 20% lower mortality and morbidity [ 5 ], including re-hospitalization and revascularization, which are a major expense to health systems [ 6 ]. Evidence from LMICs also support these significant benefits [ 7 ].…”

Section: Introductionmentioning

confidence: 99%