Cardiac rehabilitation services in low- and middle-income countries: A scoping review

Background: Despite the decreasing rate of cardiovascular disease-related mortality in developed nations, low- and middle-income countries (LMICs) are experiencing an increase. Cardiac rehabilitation (CR) successfully addresses this burden; however, the availability and nature of CR service delivery in LMICs are not well known. Objective: This scoping review examined the (1) presence and accessibility of CR services, (2) structure of CR services, and (3) effects of CR on patient outcomes in LMICs. Methods: Search criteria consisted of (1) nations considered to be low- or middle-income according to World Bank criteria, (2) CR, defined as programs including exercise and education, and (3) adults with cardiovascular diseases. Literature was identified through searching (a) the MEDLINE and EMBASE electronic databases, (b) proceedings from international cardiac conferences, (c) the grey literature and (d) through consulting experts in the field. Results: Thirty peer-reviewed publications were identified. Grey literature, including Web sites for individual CR programs, revealed that CR is available in 32 (22.1%) LMICs. The most comprehensive data on accessibility stem from Latin America and the Caribbean, where 56% of institutions with cardiac catheterization facilities offered CR. Literature showed that some programs offered exercise, dietary advice, education, and psychological support, to assist patients to resume work and other activities of daily living. Fifteen peer-reviewed studies reported on CR outcomes, most of which were positive. Conclusion: Although patients similarly benefit from CR, few programs are available in LMICs. Policies need to be implemented to increase provision of tailored CR models at the global and national level, with evaluation.