TY - JOUR
T1 - Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region
T2 - How does it compare globally?
AU - Turk-Adawi, Karam
AU - Supervia, Marta
AU - Pesah, Ella
AU - Lopez-Jimenez, Francisco
AU - Afaneh, Jasser
AU - El-Heneidy, Asmaa
AU - Sadeghi, Masoumeh
AU - Sarrafzadegan, Nizal
AU - Alhashemi, Mohammed
AU - Papasavvas, Theodoros
AU - Grace, Sherry L.
N1 - Funding Information:
This project was supported by a research grant from York University's Faculty of Health. On behalf of the International Council of Cardiovascular Prevention and Rehabilitation through which this study was undertaken, the authors are grateful in particular to EMR champions who collaborated to identify and reach programs in their country, namely: Dr. Anwar Jelani, Dr. Wael Safwat, Dr. Marouane Boukhris, and Dr. Lida Safi. We are also grateful to Ms. Anfal Adawi for her assistance with the display items. We also thank Global CR Program Survey national champions for their assistance in collecting data in other countries for comparison. We also thank the World Heart Federation, who also formally endorsed the study protocol.
Funding Information:
This project was supported by a research grant from York University 's Faculty of Health.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - Background: This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries. Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates. Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n = 8; versus globally p <.001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n = 378, 36.3% globally; p <.001). Over 80% of programs accepted guideline-indicated patients. Nurses (n = 20, 95.2%), cardiologists (n = 18, 85.7%) and dietitians (n = 18, 85.7%) were the most common healthcare providers on CR teams (mean = 6.4 ± 2.2/program; 5.9 ± 2.8 globally, p =.18). On average, programs offered 8.9 ± 1.7/11 core components (versus 8.7 ± 1.9 globally, p =.90). These were most commonly initial assessment, management of risk factors, and patient education (n = 21, 100.0% for each), and least commonly return-to-work counselling (n = 15 71.4%). Mean dose was 27.0 ± 13.5 sessions (versus 28.7 ± 27.6 globally, p =.38). Seven (33.3%) programs offered some alternative models. Conclusion: CR is insufficiently implemented, with 2,079,283 more spots needed/year across the EMR. But where offered, CR is consistent with guidelines.
AB - Background: This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries. Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates. Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n = 8; versus globally p <.001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n = 378, 36.3% globally; p <.001). Over 80% of programs accepted guideline-indicated patients. Nurses (n = 20, 95.2%), cardiologists (n = 18, 85.7%) and dietitians (n = 18, 85.7%) were the most common healthcare providers on CR teams (mean = 6.4 ± 2.2/program; 5.9 ± 2.8 globally, p =.18). On average, programs offered 8.9 ± 1.7/11 core components (versus 8.7 ± 1.9 globally, p =.90). These were most commonly initial assessment, management of risk factors, and patient education (n = 21, 100.0% for each), and least commonly return-to-work counselling (n = 15 71.4%). Mean dose was 27.0 ± 13.5 sessions (versus 28.7 ± 27.6 globally, p =.38). Seven (33.3%) programs offered some alternative models. Conclusion: CR is insufficiently implemented, with 2,079,283 more spots needed/year across the EMR. But where offered, CR is consistent with guidelines.
KW - Cardiac rehabilitation
KW - Eastern Mediterranean region
KW - Health services
KW - Survey
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U2 - 10.1016/j.ijcard.2019.02.065
DO - 10.1016/j.ijcard.2019.02.065
M3 - Article
C2 - 30904282
AN - SCOPUS:85063105218
VL - 285
SP - 147
EP - 153
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -