Cardiac Rehabilitation Availability and Density around the Globe.
Capacity
Cardiac rehabilitation
Density
Global health
Health services
Preventive cardiology
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
02
01
2019
revised:
06
06
2019
accepted:
12
06
2019
entrez:
14
9
2019
pubmed:
14
9
2019
medline:
14
9
2019
Statut:
epublish
Résumé
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. 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. 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 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.
Sections du résumé
BACKGROUND
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
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
RESULTS
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
INTERPRETATION
CONCLUSIONS
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.
Identifiants
pubmed: 31517261
doi: 10.1016/j.eclinm.2019.06.007
pii: S2589-5370(19)30100-2
pmc: PMC6737209
doi:
Types de publication
Journal Article
Langues
eng
Pagination
31-45Déclaration de conflit d'intérêts
Dr. Derman reports some financial activities that were outside the submitted work (i.e., grants from International Olympic and Paralympic Committees, as well as personal fees from 2 advisory boards). All other authors declare no financial or personal interests.
Références
J Am Coll Cardiol. 2017 Jul 4;70(1):1-25
pubmed: 28527533
J Am Coll Cardiol. 2016 Jan 5;67(1):1-12
pubmed: 26764059
J Cardiopulm Rehabil Prev. 2013 Jan-Feb;33(1):33-41
pubmed: 23235320
Int J Cardiol. 2017 Oct 1;244:322-328
pubmed: 28622943
J Cardiopulm Rehabil Prev. 2014 Jul-Aug;34(4):248-54
pubmed: 24820451
J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46
pubmed: 22055990
Heart. 2018 Sep;104(17):1403-1410
pubmed: 29654096
Glob Heart. 2017 Dec;12(4):323-334.e10
pubmed: 28302548
J Am Coll Cardiol. 2012 Dec 18;60(24):e44-e164
pubmed: 23182125
Stroke. 2015 May;46(5):e121-2
pubmed: 25873596
J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239
pubmed: 23747642
Circ J. 2007 Feb;71(2):173-9
pubmed: 17251662
BMC Health Serv Res. 2016 Sep 06;16:471
pubmed: 27600379
Nat Rev Cardiol. 2014 Oct;11(10):586-96
pubmed: 25027487
Am J Prev Med. 2009 Jan;36(1):82-88
pubmed: 19095166
Can J Cardiol. 2016 Oct;32(10 Suppl 2):S358-S364
pubmed: 27692116
Prog Cardiovasc Dis. 2017 Sep - Oct;60(2):267-280
pubmed: 28844588
Am Heart J. 2009 Sep;158(3):480-7
pubmed: 19699874
Curr Probl Cardiol. 2010 Feb;35(2):72-115
pubmed: 20109979
BMC Health Serv Res. 2015 Nov 26;15:521
pubmed: 26607235
Heart. 2016 Sep 15;102(18):1449-55
pubmed: 27181874