University of Oulu

Karam Turk-Adawi, Marta Supervia, Francisco Lopez-Jimenez, Ella Pesah, Rongjing Ding, Raquel R. Britto, Birna Bjarnason-Wehrens, Wayne Derman, Ana Abreu, Abraham S. Babu, Claudia Anchique Santos, Seng Khiong 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, Cardiac Rehabilitation Availability and Density around the Globe, EClinicalMedicine, Volume 13, 2019, Pages 31-45, ISSN 2589-5370, https://doi.org/10.1016/j.eclinm.2019.06.007

Cardiac rehabilitation availability and density around the globe

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Author: Turk-Adawi, Karam1; Supervia, Marta2,3; Lopez-Jimenez, Francisco3;
Organizations: 1QU Health, Qatar University, Al Jamiaa St, Doha, Qatar
2Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain
3Mayo Clinic, Rochester, 200 First St. SW, Rochester, MN 55905, USA
4York University, 4700 Keele Street, Toronto, Ontario M3J1P3, Canada
5Peiking University People' Hospital, 11 Xizhimen S St, Xicheng Qu, Beijing Shi, China
6Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG 31270-901, Brazil
7Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
8Stellenbosch University & International Olympic Committee Research Center South Africa, Francie Van Zijl Drive, Stellenbosch 7599, South Africa
9Hospital Santa Marta, 1169-024, R. de Santa Marta 50, Lisbon, Portugal
10Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal - 576104, Karnataka
11Mediagnóstica Duitama, Cra16 #14- 68 oficina 201, Duitama, Boyacá, Colombia
12Hospital Raja Isteri Pengiran Anak Saleha, Bandar Seri Begawan BA1710, Brunei
13Philippine Heart Center, East Avenue, Quezon City, Philippines 1100
14National University Heart Centre Singapore, National University Health System (NUHS) Tower Block, 1E Kent Ridge Road, Level 9, Cardiac Department, Singapore 119228, Singapore
15University of the West Indies at Cave Hill, St. Michael, Barbados
16University of Iceland, Saemundargata 2, IS-101, Reykjavik, Iceland
17Central Hospital of Social Security Institute, Asuncion, Paraguay
18Institute of Cardiovascular Diseases, Clinical Center of Serbia, Dr. Koste Todorovića 8, 11000 Beograd, Serbia
19University of Banja Luka, Faculty of Medicine, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
20Institute of Cardiology, Str. Testemitanu, 20, Chisinau, Republic of Moldova
21Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, Wales, United Kingdom
22Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
23Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak Mah Muhsin Yazıcıoğlu Cad. No:10 Üst Kaynarca Pendik / İstanbul, Turkey
24Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea
25ASCARDIO, 17 Callejón 12, Barquisimeto 3001, Lara, Venezuela
26ICCCV Instituto de Cardiología y Cirugía Cardiovascular, No. 702 entre A y Paseo, Vedado, Calle 17, La Habana, Cuba
27INCOR Instituto Nacional Cardiovascular, Jirón Coronel Zegarra, Jesus Maria, Lima 11, Peru
28National Cardiovascular Center Harapan Kita, Kav 87, Jl. Letjen. S. Parman, Jakarta, Indonesia
29University of Medicine & Pharmacy "Victor Babes "Cardiovascular Prevention & Rehabilitation Clinic, Bvd CD Loga 49, 300020 Timisoara, Romania
30State Hospital for Cardiology, Balatonfüred, Gyógy tér 2, 8230, Hungary
31Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
32The University of Auckland, 71 Merton Road, Private Bag 92019, Auckland 1142, New Zealand
3312 Octubre Universitary Hospital, Av. Cordoba, s/n, 28041 Madrid, Spain
34Tbilisi State Medical University, 33 Vazha Pshavela Ave, Tbilisi, Georgia
35Spanish Association Hospital, 11200, Bulevar Gral. Artigas, 1471 Montevideo, Uruguay
36PHYSIS Prevencion Cardiovascular, Cdla Bolivariana Av. del Libertador - Mz I Villa 5, Guayaquil, Ecuador
37Instituto Nacional de Cardiología, Belisario Domínguez Sección 16, Belisario Domínguez Secc 16, 14080 Tlalpan, CDMX, Mexico
38Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar-Jerib Ave., Isfahan, IR 81746 73461, Iran
39University of Palacky, University Hospital Olomouc, I.P. Pavlova 185/6, Nová Ulice, 779 00 Olomouc, Czech Republic
40Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital, University of Oulu, Finland
41Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas 44307, Lithuania
42Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Pavia, Italy
43Edinburgh Napier University, 9 Sighthill Ct, Edinburgh EH11 4BN, Scotland, United Kingdom
44Shaare Zedek Medical Center, the Hebrew University, Jerusalem, Israel
45Maxima Medical Centre, De Run 4600, 5504, DB, Veldhoven, Netherlands
46Ślaskie Centrum Rehabilitacji w Ustroniu, Zdrojowa 6, 43-450 Ustroń, Poland
47Heart House Martin, Bagarova 30, Martin (Podháj), Slovakia
48Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom
49Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Copenhagen, Denmark
50Sociedad Chilena de Cardiología, Alfredo Barros Errázuriz 1954, Providencia, Región Metropolitana, Chile
51Cardiovascular Institute of Buenos Aires, Av. del Libertador 6302, 1428 Buenos Aires, Argentina
52Loire-Vendée-Océan hospital, Boulevard des Régents, 44270 Machecoul, France
53Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
54University of British Columbia,2206 East Mall, Vancouver, BC V6T 1Z3, Canada
55Moncton Hospital, 135 Macbeath Ave, Moncton, NB E1C 6Z8, Canada
56Beijing United Family Hospital, 2 Jiangtai Rd, Chaoyang Qu, Beijing Shi, China, 100096
57KITE-University Health Network, 399 Bathurst St, Toronto, ON M5T 2S8, Canada
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe202003198543
Language: English
Published: Elsevier, 2019
Publish Date: 2020-03-19
Description:

Abstract

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.

Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.

Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < 0.001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = 0.92, 95%CI = 0.91–0.93) or public (OR = 0.83, 95%CI = 0.82–0.84) funding compared to hybrid sources.

Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25–Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.

Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

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Series: EClinicalMedicine
ISSN: 2589-5370
ISSN-E: 2589-5370
ISSN-L: 2589-5370
Volume: 13
Pages: 31 - 45
DOI: 10.1016/j.eclinm.2019.06.007
OADOI: https://oadoi.org/10.1016/j.eclinm.2019.06.007
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Funding: This research was supported by a grant from York University's Faculty of Health. The funder had no role in study design, data collection, data analysis, interpretation or writing of the report.
Copyright information: © 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  https://creativecommons.org/licenses/by-nc-nd/4.0/