Nature of Cardiac Rehabilitation Around the Globe

Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05).Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.

Supervia Marta, Turk-Adawi Karam, Lopez-Jimenez Francisco, Pesah Ella, Ding Rongjing, Britto Raquel R., Bjarnason-Wehrens Birna, Derman Wayne, Abreu Ana, Babu Abraham S., Anchique Santos Claudia, Jong Seng K., Cuenza Lucky, Yeo Tee Joo, Scantlebury Dawn, Andersen Karl, Gonzalez Graciela, Giga Vojislav, Vulic Dusko, Vataman Eleonora, Cliff Jacqueline, Kouidi Evangelia, Yagci Ilker, Kim Chul, Benaim Briseida, Estany Eduardo Rivas, Fernandez Rosalia, Radi Basuni, Gaita Dan, Simon Attila, Chen Ssu-Yuan, Roxburgh Brendon, Martin Juan Castillo, Maskhulia Lela, Burdiat Gerard, Salmon Richard, Lomelí Hermes, Sadeghi Masoumeh, Sovova Eliska, Hautala Arto, Tamuleviciute-Prasciene Egle, Ambrosetti Marco, Neubeck Lis, Asher Elad, Kemps Hareld, Eysymontt Zbigniew, Farsky Stefan, Hayward Jo, Prescott Eva, Dawkes Susan, Santibanez Claudio, Zeballos Cecilia, Pavy Bruno, Kiessling Anna, Sarrafzadegan Nizal, Baer Carolyn, Thomas Randal, Hu Dayi, Grace Sherry L.

A1 Journal article – refereed

Marta Supervia, Karam Turk-Adawi, Francisco Lopez-Jimenez, Ella Pesah, Rongjing Ding, Raquel R. Britto, Birna Bjarnason-Wehrens, Wayne Derman, Ana Abreu, Abraham S. Babu, Claudia Anchique Santos, Seng K. Jong, Lucky Cuenza, Tee Joo Yeo, Dawn Scantlebury, Karl Andersen, Graciela Gonzalez, Vojislav Giga, Dusko Vulic, Eleonora Vataman, Jacqueline Cliff, Evangelia Kouidi, Ilker Yagci, Chul Kim, Briseida Benaim, Eduardo Rivas Estany, Rosalia Fernandez, Basuni Radi, Dan Gaita, Attila Simon, Ssu-Yuan Chen, Brendon Roxburgh, Juan Castillo Martin, Lela Maskhulia, Gerard Burdiat, Richard Salmon, Hermes Lomelí, Masoumeh Sadeghi, Eliska Sovova, Arto Hautala, Egle Tamuleviciute-Prasciene, Marco Ambrosetti, Lis Neubeck, Elad Asher, Hareld Kemps, Zbigniew Eysymontt, Stefan Farsky, Jo Hayward, Eva Prescott, Susan Dawkes, Claudio Santibanez, Cecilia Zeballos, Bruno Pavy, Anna Kiessling, Nizal Sarrafzadegan, Carolyn Baer, Randal Thomas, Dayi Hu, Sherry L. Grace, Nature of Cardiac Rehabilitation Around the Globe, EClinicalMedicine, Volume 13, 2019, Pages 46-56, ISSN 2589-5370,

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