National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II)

Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases.Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.Keywords: cardiac rehabilitation, global health, secondary prevention Alphabetical List of Abbreviations: AS= administrative support CABG = coronary artery bypass graft CB = community-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 CR = cardiac rehabilitation CPR= cardiopulmonary resuscitation CVD = cardiovascular disease ECG = electrocardiogram EQ= equipment ET = exercise training FR= financial resources HB = home-based HF = heart failure HR= human resources IA = initial assessment IB = internet-based IHD = ischemic heart disease LMIC = low-and middle-income country MI = myocardial infarction NC = nutrition counseling NZ = New Zealand PAW= patient awareness PCI = percutaneous coronary intervention PE = patient education PR= patient referral RF = risk factor management SC = smoking cessation SM = stress management and/or psychosocial support/counselling TI = transportation issues UAE = United Arab Emirates VAD = ventricular assist device A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 By 2030, it is expected 84 million individuals will be diagnosed with cardiovascular disease (CVD) 1 .Moreover, it is among the leading causes of disability around the world, and contributes to 10% of disabilityadjusted life years lost world-wide 2 . With improved survival (in high-income countries 3 ), clearly there is a great need for secondary prevention, such as is offered in cardiac rehabilitation (CR) programs.Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 . Accordingly, it is a class 1 level A recommendation in clinical practice guidelines for CVD patients 9,10 . 19 , have established guidelines to ensure consistent provision and quality of CR delivery in order to achieve the greatest population health benefits. They all outline the nature of patients indicated for services, and make recommendations regarding the composition of a multi-disciplinary...

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“…In the first 74 , findings revealed CR teams were also composed of nurses (79. %), nutritionists (79%) and psychologists/psychiatrists (71%).…”

Section: Cr Delivery In Latin America and The Caribbeanmentioning

confidence: 99%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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“…In the Get With the Guidelines‐Heart Failure Registry, the referral rate to CR programmes in hospitalized HF patients was only 10.4%, with the main clinical factors associated with lack of referral being older age, female gender, and co‐morbidities . Besides our experience, only one report from a single country of Central America has analysed non‐clinical reasons for CR and ETP referral . Only 4.4% of eligible patients were referred to CR in Mexico, and financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%) were reported …”

Section: Discussionmentioning

confidence: 80%

“…Besides our experience, only one report from a single country of Central America has analysed non‐clinical reasons for CR and ETP referral . Only 4.4% of eligible patients were referred to CR in Mexico, and financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%) were reported …”

Section: Discussionmentioning

confidence: 90%

Regional differences in exercise training implementation in heart failure: findings from the Exercise Training in Heart Failure (ExTraHF) survey

Piepoli

Binno

Coats

et al. 2019

European J of Heart Fail

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Background Exercise training programmes (ETPs) are a crucial component in cardiac rehabilitation in heart failure (HF) patients. The Exercise Training in HF (ExTraHF) survey has reported poor implementation of ETPs in countries affiliated to the European Society of Cardiology (ESC). The aim of the present sub‐analysis was to investigate the regional variations in the implementation of ETPs for HF patients. Methods and results The study was designed as a web‐based survey of cardiac units, divided into five areas, according to the geographical location of the countries surveyed. Overall, 172 centres replied to the survey, in charge of 78 514 patients, differentiated in 52 Northern (n = 15 040), 48 Southern (n = 27 127), 34 Western (n = 11 769), 24 Eastern European (n = 12 748), and 14 extra‐European centres (n = 11 830). Greater ETP implementation was observed in Western (76%) and Northern (63%) regions, whereas lower rates were seen in Southern (58%), Eastern European (50%) and extra‐European (36%) regions. The leading barrier was the lack of resources in all (83–65%) but Western region (37%) where patients were enrolled in dedicated settings and specialized units (75%). In 40% of centres, non‐inclusion of ETP in the national or local guideline pathway accounted for the lack of ETP implementation. Conclusion Exercise training programmes are poorly implemented in the ESC affiliated countries, mainly because of the lack of resources and/or national and local guidelines. The linkage with dedicated cardiac rehabilitation centres (as in the Western region) or the model of local rehabilitation services adopted in Northern countries may be considered as options to overcome these gaps.

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“…Representative population-based data on completion rates are available in the United Kingdom's CR registry; results suggest 77% of participants complete CR [23] (but caution is warranted in overinterpretation as sites may not enter data for patients who only attend an initial session). Utilization rates are even lower in lower-income countries [24,25] where the epidemic of CVD is at its' worst.…”

Section: Introductionmentioning

confidence: 99%

Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Pio

Beckie

Varnfield

et al. 2020

International Journal of Cardiology

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Background: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. Methods: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was

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National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II)

Cited by 15 publications

References 12 publications

A Review of Cardiac Rehabilitation Delivery Around the World

A Review of Cardiac Rehabilitation Delivery Around the World

Regional differences in exercise training implementation in heart failure: findings from the Exercise Training in Heart Failure (ExTraHF) survey

Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

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