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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

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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