Ana Abreu1, Ella Pesah2, Marta Supervia3, Karam Turk-Adawi4, Birna Bjarnason-Wehrens5, Francisco Lopez-Jimenez6, Marco Ambrosetti7, Karl Andersen8, Vojislav Giga9, Dusko Vulic10, Eleonora Vataman11, Dan Gaita12, Jacqueline Cliff13, Evangelia Kouidi14, Ilker Yagci15, Attila Simon16, Arto Hautala17, Egle Tamuleviciute-Prasciene18, Hareld Kemps19, Zbigniew Eysymontt20, Stefan Farsky21, Jo Hayward22, Eva Prescott23, Susan Dawkes24, Bruno Pavy25, Anna Kiessling26, Eliska Sovova27, Sherry L Grace2,28. 1. 1 Cardiology Department, Hospital Santa Maria, Portugal. 2. 2 Department of Kinesiology and Health Sciences, York University, Canada. 3. 3 Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Spain. 4. 4 Department of Public Health, Qatar University, Qatar. 5. 5 Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany. 6. 6 Department of Cardiovascular Medicine, Mayo Clinic, USA. 7. 7 Istituti Clinici Scientifici Maugeri, Care and Research Institute Department of Cardiac Rehabilitation, Italy. 8. 8 Department of Internal Medicine, University of Iceland, Iceland. 9. 9 Institute of Cardiovascular Diseases, Clinical Center of Serbia, Serbia. 10. 10 University of Banja Luka, Center for Medical Research, Bosnia and Herzegovina. 11. 11 Institute of Cardiology, Moldova Academy of Science, Republica Moldova. 12. 12 University of Medicine and Pharmacy "Victor Babes", Cardiovascular Prevention and Rehabilitation Clinic, Romania. 13. 13 Cardiac Rehabilitation Department, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, UK. 14. 14 Department of First Internal Medicine, Aristotle University of Thessaloniki, Greece. 15. 15 Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Turkey. 16. 16 Cardiac Rehabilitation Department, State Hospital for Cardiology, Hungary. 17. 17 Cardiovascular Research Group, Oulu University Hospital, Finland. 18. 18 Department of Rehabilitation, Lithuanian University of Health Sciences, Lithuania. 19. 19 Department of Cardiology, Maxima Medical Centre, The Netherlands. 20. 20 Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Poland. 21. 21 Cardiology Department, Heart House Martin, Slovakia. 22. 22 Cardiology Department, Norfolk and Norwich University Hospital, UK. 23. 23 Cardiology Department, Bispebjerg Frederiksberg Hospital, Denmark. 24. 24 School of Health and Social Care, Edinburgh Napier University, UK. 25. 25 Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, France. 26. 26 Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Sweden. 27. 27 Department of Internal Medicine, University of Palacky, University Hospital Olomouc, Czech Republic. 28. 28 Toronto Rehabiliation Institute, University Health Network, Canada.
Abstract
AIMS: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries. METHODS: 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. Four high-income countries were selected for comparison (N = 790 programmes) to European data, and multilevel analyses were performed. RESULTS: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries (P < 0.001). Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programmes were funded by social security (n = 25, 59.5%; with significant regional variation, P < 0.001), but in 72 (16.0%) patients paid some or all of the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences, P < 0.05). CONCLUSION: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.
AIMS: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries. METHODS: 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. Four high-income countries were selected for comparison (N = 790 programmes) to European data, and multilevel analyses were performed. RESULTS: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries (P < 0.001). Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programmes were funded by social security (n = 25, 59.5%; with significant regional variation, P < 0.001), but in 72 (16.0%) patients paid some or all of the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences, P < 0.05). CONCLUSION: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.
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