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Cardiac Rehabilitation Availability and Density Around the Globe Publisher



Turkadawi K1 ; Supervia M2, 3 ; Lopezjimenez F3 ; Pesah E4 ; Ding R5 ; Britto RR6 ; Bjarnasonwehrens B7 ; Derman W8 ; Abreu A9 ; Babu AS10 ; Santos CA11 ; Jong SK12 ; Cuenza L13 ; Yeo TJ14 Show All Authors
Authors
  1. Turkadawi K1
  2. Supervia M2, 3
  3. Lopezjimenez F3
  4. Pesah E4
  5. Ding R5
  6. Britto RR6
  7. Bjarnasonwehrens B7
  8. Derman W8
  9. Abreu A9
  10. Babu AS10
  11. Santos CA11
  12. Jong SK12
  13. Cuenza L13
  14. Yeo TJ14
  15. Scantlebury D15
  16. Andersen K16
  17. Gonzalez G17
  18. Giga V18
  19. Vulic D19
  20. Vataman E20
  21. Cliff J21
  22. Kouidi E22
  23. Yagci I23
  24. Kim C24
  25. Benaim B25
  26. Estany ER26
  27. Fernandez R27
  28. Radi B28
  29. Gaita D29
  30. Simon A30
  31. Chen SY31
  32. Roxburgh B32
  33. Martin JC33
  34. Maskhulia L34
  35. Burdiat G35
  36. Salmon R36
  37. Lomeli H37
  38. Sadeghi M38
  39. Sovova E39
  40. Hautala A40
  41. Tamuleviciuteprasciene E41
  42. Ambrosetti M42
  43. Neubeck L43
  44. Asher E44
  45. Kemps H45
  46. Eysymontt Z46
  47. Farsky S47
  48. Hayward J48
  49. Prescott E49
  50. Dawkes S43
  51. Santibanez C50
  52. Zeballos C51
  53. Pavy B52
  54. Kiessling A53
  55. Sarrafzadegan N38, 54
  56. Baer C55
  57. Thomas R3
  58. Hu D56
  59. Grace SL4, 57
Show Affiliations
Authors Affiliations
  1. 1. QU Health, Qatar University, Al Jamiaa St, Doha, Qatar
  2. 2. Gregorio Maranon General University Hospital, Gregorio Maranon Health Research Institute, Dr. Esquerdo, 46, Madrid, 28007, Spain
  3. 3. Mayo Clinic, Rochester, 200 First St. SW, Rochester, 55905, MN, United States
  4. 4. York University, 4700 Keele Street, Toronto, M3J1P3, Ontario, Canada
  5. 5. Peiking University People' Hospital, 11 Xizhimen S St, Xicheng Qu, Beijing Shi, China
  6. 6. Universidade Federal de Minas Gerais, Av. Pres. Antonio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-901, MG, Brazil
  7. 7. Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Am Sportpark Mungersdorf 6, Cologne, 50933, Germany
  8. 8. Stellenbosch University & International Olympic Committee Research Center South Africa, Francie Van Zijl Drive, Stellenbosch, 7599, South Africa
  9. 9. Hospital Santa Marta, 1169-024, R. de Santa Marta 50, Lisbon, Portugal
  10. 10. Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
  11. 11. Mediagnostica Duitama, Cra16 #14- 68 oficina 201, Duitama, Boyaca, Colombia
  12. 12. Hospital Raja Isteri Pengiran Anak Saleha, Bandar Seri Begawan, BA1710, Brunei Darussalam
  13. 13. Philippine Heart Center, East Avenue, Quezon City, 1100, Philippines
  14. 14. National University Heart Centre Singapore, Cardiac Department, National University Health System (NUHS) Tower Block, 1E Kent Ridge Road, Level 9, Singapore, 119228, Singapore
  15. 15. University of the West Indies at Cave Hill, St. Michael, Barbados
  16. 16. University of Iceland, Saemundargata 2, IS-101, Reykjavik, Iceland
  17. 17. Central Hospital of Social Security Institute, Asuncion, Paraguay
  18. 18. Institute of Cardiovascular Diseases, Clinical Center of Serbia, Dr. Koste Todorovica 8, Beograd, 11000, Serbia
  19. 19. University of Banja Luka, Faculty of Medicine, Save Mrkalja 14, Banja Luka, 78000, Bosnia and Herzegovina
  20. 20. Institute of Cardiology, Str. Testemitanu, 20, Chisinau, Moldova
  21. 21. Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, Wales, United Kingdom
  22. 22. Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, 57001, Greece
  23. 23. Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Cakmak Mah Muhsin Yazicioglu Cad. No:10 Ust Kaynarca Pendik / Istanbul, Turkey
  24. 24. Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, South Korea
  25. 25. ASCARDIO, 17 Callejon 12, Barquisimeto, 3001, Lara, Venezuela
  26. 26. ICCCV Instituto de Cardiologia y Cirugia Cardiovascular, No. 702 entre A y Paseo, Vedado, Calle 17, La Habana, Cuba
  27. 27. INCOR Instituto Nacional Cardiovascular, Jiron Coronel Zegarra, Jesus Maria, Lima 11, Peru
  28. 28. National Cardiovascular Center Harapan Kita, Kav 87, Jl. Letjen. S. Parman, Jakarta, Indonesia
  29. 29. University of Medicine & Pharmacy Victor Babes Cardiovascular Prevention & Rehabilitation Clinic, Bvd CD Loga 49, Timisoara, 300020, Romania
  30. 30. State Hospital for Cardiology, Balatonfured, Gyogy ter 2, 8230, Hungary
  31. 31. Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 24352, Taiwan
  32. 32. The University of Auckland, 71 Merton Road, Private Bag 92019, Auckland, 1142, New Zealand
  33. 33. 12 Octubre Universitary Hospital, Av. Cordoba, s/n, Madrid, 28041, Spain
  34. 34. Tbilisi State Medical University, 33 Vazha Pshavela Ave, Tbilisi, Georgia
  35. 35. Spanish Association Hospital, 11200, Bulevar Gral. Artigas, Montevideo, 1471, Uruguay
  36. 36. PHYSIS Prevencion Cardiovascular, Cdla Bolivariana Av. del Libertador - Mz I Villa 5, Guayaquil, Ecuador
  37. 37. Instituto Nacional de Cardiologia, Belisario Dominguez Seccion 16, Belisario Dominguez Secc 16, 14080 Tlalpan, CDMX, Mexico
  38. 38. Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar-Jerib Ave., Isfahan, 81746 73461, IR, Iran
  39. 39. University of Palacky, University Hospital Olomouc, I.P. Pavlova 185/6, Nova Ulice, Olomouc, 779 00, Czech Republic
  40. 40. Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital, University of Oulu, Finland
  41. 41. Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, Kaunas, 44307, Lithuania
  42. 42. Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Pavia, Italy
  43. 43. Edinburgh Napier University, 9 Sighthill Ct, Edinburgh, EH11 4BN, Scotland, United Kingdom
  44. 44. Shaare Zedek Medical Center, the Hebrew University, Jerusalem, Israel
  45. 45. Maxima Medical Centre, De Run 4600, Veldhoven, 5504, DB, Netherlands
  46. 46. Slaskie Centrum Rehabilitacji w Ustroniu, Zdrojowa 6, Ustron, 43-450, Poland
  47. 47. Heart House Martin, Bagarova 30, Martin (Podhaj), Slovakia
  48. 48. Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, United Kingdom
  49. 49. Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Kobenhavn, Copenhagen, NV, Denmark
  50. 50. Sociedad Chilena de Cardiologia, Alfredo Barros Errazuriz 1954, Providencia, Region Metropolitana, Chile
  51. 51. Cardiovascular Institute of Buenos Aires, Av. del Libertador 6302, Buenos Aires, 1428, Argentina
  52. 52. Loire-Vendee-Ocean hospital, Boulevard des Regents, Machecoul, 44270, France
  53. 53. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
  54. 54. University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada
  55. 55. Moncton Hospital, 135 Macbeath Ave, Moncton, E1C 6Z8, NB, Canada
  56. 56. Beijing United Family Hospital, 2 Jiangtai Rd, Chaoyang Qu, Beijing Shi, 100096, China
  57. 57. KITE-University Health Network, 399 Bathurst St, Toronto, M5T 2S8, ON, Canada

Source: EClinicalMedicine Published:2019


Abstract

Background: Despite 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. Methods: A 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. Findings: CR 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. Interpretation: CR 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. © 2019
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