Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries

Raquel Rodrigues Britto, Marta Supervia, Karam Turk-Adawi, Gabriela Suéllen da Silva Chaves, Ella Pesah, Francisco Lopez-Jimenez, Danielle Aparecida Gomes Pereira, Artur H. Herdy, Sherry L. Grace

Research output: Contribution to journalArticle

Abstract

Background: Brazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. Objective: This study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). Methods: In this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N = 249 programmes). Results: Cardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n = 16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8 ± 1.9 staff (versus 5.9 ± 2.8 in other upper-MICs, p < 0.05), offering 4.0 ± 1.6/10 core components (versus 6.0 ± 1.5 in other upper-MICs, p < 0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25–75 = 29–65) vs. 32 sessions/patient (Q25–75 = 15–40) in other upper-MICs (p < 0.01). Conclusion: Brazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.

Original languageEnglish (US)
JournalBrazilian Journal of Physical Therapy
DOIs
StatePublished - Jan 1 2019

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Brazil
Myocardial Ischemia
Guidelines
Tobacco Use Cessation
Cardiac Volume
Return to Work
South America
Health Insurance
Cardiac Rehabilitation
Counseling
Cross-Sectional Studies
Incidence

Keywords

  • Availability
  • Health services
  • Rehabilitation
  • Upper-middle income country

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine
  • Rehabilitation

Cite this

Cardiac rehabilitation availability and delivery in Brazil : a comparison to other upper middle-income countries. / Britto, Raquel Rodrigues; Supervia, Marta; Turk-Adawi, Karam; Chaves, Gabriela Suéllen da Silva; Pesah, Ella; Lopez-Jimenez, Francisco; Pereira, Danielle Aparecida Gomes; Herdy, Artur H.; Grace, Sherry L.

In: Brazilian Journal of Physical Therapy, 01.01.2019.

Research output: Contribution to journalArticle

Britto, Raquel Rodrigues ; Supervia, Marta ; Turk-Adawi, Karam ; Chaves, Gabriela Suéllen da Silva ; Pesah, Ella ; Lopez-Jimenez, Francisco ; Pereira, Danielle Aparecida Gomes ; Herdy, Artur H. ; Grace, Sherry L. / Cardiac rehabilitation availability and delivery in Brazil : a comparison to other upper middle-income countries. In: Brazilian Journal of Physical Therapy. 2019.
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abstract = "Background: Brazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. Objective: This study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). Methods: In this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N = 249 programmes). Results: Cardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0{\%} programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n = 16, 53.3{\%}), but in 11 programmes (36.7{\%}) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70{\%} of programmes. Programmes had a team of 3.8 ± 1.9 staff (versus 5.9 ± 2.8 in other upper-MICs, p < 0.05), offering 4.0 ± 1.6/10 core components (versus 6.0 ± 1.5 in other upper-MICs, p < 0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25–75 = 29–65) vs. 32 sessions/patient (Q25–75 = 15–40) in other upper-MICs (p < 0.01). Conclusion: Brazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.",
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AU - Britto, Raquel Rodrigues

AU - Supervia, Marta

AU - Turk-Adawi, Karam

AU - Chaves, Gabriela Suéllen da Silva

AU - Pesah, Ella

AU - Lopez-Jimenez, Francisco

AU - Pereira, Danielle Aparecida Gomes

AU - Herdy, Artur H.

AU - Grace, Sherry L.

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N2 - Background: Brazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. Objective: This study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). Methods: In this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N = 249 programmes). Results: Cardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n = 16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8 ± 1.9 staff (versus 5.9 ± 2.8 in other upper-MICs, p < 0.05), offering 4.0 ± 1.6/10 core components (versus 6.0 ± 1.5 in other upper-MICs, p < 0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25–75 = 29–65) vs. 32 sessions/patient (Q25–75 = 15–40) in other upper-MICs (p < 0.01). Conclusion: Brazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.

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