Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally?

Karam Turk-Adawi, Marta Supervia, Ella Pesah, Francisco Lopez-Jimenez, Jasser Afaneh, Asmaa El-Heneidy, Masoumeh Sadeghi, Nizal Sarrafzadegan, Mohammed Alhashemi, Theodoros Papasavvas, Sherry L. Grace

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StatePublished - Jan 1 2019

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Mediterranean Region
Myocardial Ischemia
Guidelines
Cardiac Rehabilitation
Return to Work
Nutritionists
Patient Education
Health Expenditures
Health Personnel
Counseling
Cross-Sectional Studies
Nurses

Keywords

  • Cardiac rehabilitation
  • Eastern Mediterranean region
  • Health services
  • Survey

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region : How does it compare globally? / Turk-Adawi, Karam; Supervia, Marta; Pesah, Ella; Lopez-Jimenez, Francisco; Afaneh, Jasser; El-Heneidy, Asmaa; Sadeghi, Masoumeh; Sarrafzadegan, Nizal; Alhashemi, Mohammed; Papasavvas, Theodoros; Grace, Sherry L.

In: International Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Turk-Adawi, K, Supervia, M, Pesah, E, Lopez-Jimenez, F, Afaneh, J, El-Heneidy, A, Sadeghi, M, Sarrafzadegan, N, Alhashemi, M, Papasavvas, T & Grace, SL 2019, 'Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally?', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2019.02.065
Turk-Adawi, Karam ; Supervia, Marta ; Pesah, Ella ; Lopez-Jimenez, Francisco ; Afaneh, Jasser ; El-Heneidy, Asmaa ; Sadeghi, Masoumeh ; Sarrafzadegan, Nizal ; Alhashemi, Mohammed ; Papasavvas, Theodoros ; Grace, Sherry L. / Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region : How does it compare globally?. In: International Journal of Cardiology. 2019.
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abstract = "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.",
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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.

PY - 2019/1/1

Y1 - 2019/1/1

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.

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