Cardiac Rehabilitation Delivery Model for Low-Resource Settings Publisher Pubmed



Grace SL¹ ; Turkadawi KI² ; Contractor A³ ; Atrey A⁴ ; Campbell N⁵ ; Derman W⁶ ; Ghisi GLM⁷ ; Oldridge N⁸ ; Sarkar BK⁹ ; Yeo TJ¹⁰ ; Lopezjimenez F¹¹ ; Mendis S¹² ; Oh P¹³ ; Hu D¹⁴ Show All Authors Show Affiliations
Source: Heart Published:2016

Abstract

Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Results Available data on cost of CR delivery in lowresource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by nonphysician healthcare workers, in non-clinical settings. Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.