Raquel Rodrigues Britto1, Marta Supervia2, Karam Turk-Adawi3, Gabriela Suéllen da Silva Chaves4, Ella Pesah5, Francisco Lopez-Jimenez6, Danielle Aparecida Gomes Pereira4, Artur H Herdy7, Sherry L Grace8. 1. Rehabilitation Science Doctorate Program, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Electronic address: r3britto@gmail.com. 2. Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, United States. 3. QU Health, Qatar University, Doha, Qatar. 4. Rehabilitation Science Doctorate Program, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. 5. Faculty of Health, York University, Toronto, Canada. 6. Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, United States. 7. Instituto Cardiologia de Santa Catarina, Universidade do Sul de Santa Catarina, Florianópolis, SC, Brazil. 8. Faculty of Health, York University, Toronto, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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.
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 diseasepatient. 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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Authors: 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 Journal: EClinicalMedicine Date: 2019-07-04
Authors: Ana Paula Lima; Isabella Oliveira Nascimento; Anne Caroline A Oliveira; Thiago Henrique S Martins; Danielle A Gomes Pereira; Raquel Rodrigues Britto Journal: JMIR Res Protoc Date: 2019-11-07
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