Audry Chacin-Suarez1, Sherry L Grace2, Claudia Anchique-Santos3, Marta Supervia4, Karam Turk-Adawi5, Raquel R Britto6, Dawn C Scantlebury7, Felipe Araya-Ramirez8, Graciela Gonzalez9, Briseida Benaim10, Rosalia Fernandez11, Jacqueline Hol12, Gerard Burdiat13, Richard Salmon14, Hermes Lomeli15, Taslima Mamataz2, Jose R Medina-Inojosa1, Francisco Lopez-Jimenez16. 1. Mayo Clinic, Rochester, United States of America. 2. York University & University Health Network (KITE & Peter Munk Cardiac Centre), University of Toronto, Canada. 3. Mediagnóstica Duitama, Boyacá, Colombia. 4. Mayo Clinic, Rochester, United States of America; Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain. 5. Qatar University, Doha, Qatar. 6. Federal University of Minas Gerais, Belo Horizonte, Brazil. 7. University of the West Indies at Cave Hill, St. Michael, Barbados. 8. Center of Cardiovascular Rehabilitation, National University, Costa Rica. 9. National Cardiovascular Prevention Program, Asunción, Paraguay. 10. Asociación Cardiovascular Centro-occidental (ASCARDIO), Barquisimeto, Venezuela. 11. Instituto Nacional Cardiovascular (INCOR), Lima, Perú. 12. Rafana Medical Exercise Center, Willemstad, Curaçao. 13. Spanish Association Hospital, Montevideo, Uruguay. 14. PHYSIS Prevención Cardiovascular, Guayaquil, Ecuador. 15. Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, México. 16. Mayo Clinic, Rochester, United States of America. Electronic address: lopez@mayo.edu.
Abstract
BACKGROUND: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median=3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs. 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally p<.001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0±2.3 staff (vs 6.0±2.8 globally; p<.001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; p<.001). Median dose of CR was 36 sessions (vs 24 globally; p<.001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; p<.01). CONCLUSION: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.
BACKGROUND: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median=3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs. 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally p<.001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0±2.3 staff (vs 6.0±2.8 globally; p<.001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; p<.001). Median dose of CR was 36 sessions (vs 24 globally; p<.001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; p<.01). CONCLUSION: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.
Authors: Gabriela Lima de Melo Ghisi; Sherry L Grace; Claudia V Anchique; Ximena Gordillo; Rosalía Fernandez; Daniel Quesada; Blanca Arrieta Loaiciga; Patricia Reyes; Elena Chaparro; Renzo Soca Meza; Julia Fernandez Coronado; Marco Heredia Ñahui; Rocio Palomino Vilchez; Paul Oh Journal: Patient Educ Couns Date: 2020-10-13