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Enhancing Cardiac Rehabilitation in Low-Resource Settings: Practical Strategies

Learn about innovative models to deliver affordable cardiac rehab, develop national policies, incorporate CR in curricula, and expand human resources for better outcomes in LMICs. Next steps include literature review, panel review, and field testing. Contact sgrace@yorku.ca for more info.

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Enhancing Cardiac Rehabilitation in Low-Resource Settings: Practical Strategies

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  1. Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR Sherry L. Grace, PhD Secretary/Treasurer, ICCPR Full Professor, York University Director of Research, Cardiac Rehab University Health Network

  2. I, Sherry Grace DO NOT have a financial interest/arrangement or affiliation with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Disclosure Statement of Financial Interest

  3. WHO Global Atlas CVD Prev & Control,2011

  4. Availability of CR Globally Adawi et al., (accepted in principle) Nature Reviews: Cardiology

  5. Global Availability of CR by Country Income Classification High-incomecountries: 68.0% (51/75 countries) • Middle-income countries: 28.2% (29/103 countries) • Low-income countries: 8.3% (3/36 countries) LMICs: 23.0% Globally:38.8%(83/214 countries) Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (accepted in principle). Nature Reviews: Cardiology.

  6. 21 Associations of the

  7. 1993

  8. “define health system-related opportunities … to access for … rehabilitation … and develop feasible and integrated approaches to apply cost-effective NCD interventions at all levels of health care” 2011; p. 46

  9. CR delivery model for low-resource settings: A consensus statement • Primary Writing Panel • Grace, S.L., Turk-Adawi, K., Contractor, A., Atrey, A., Campbell, N., Derman, W., Ghisi, G.M.G., Hu, D., Lopez, F., Mendis, S.,(WHO) & Sarrafzadegan, N. • Secondary Writing Panel • Buckley, J., Akinroye, K. (WHF), Mola, A., Neubeck, L., Pogosova, N., & Rivas-Estany, E.

  10. Literature Review: Search Strategy 1. Comprehensive search using Medline and Embase a- cardiac diseases b- rehabilitation c- LMICs 2. Grey literature search for reports, guidelines

  11. Buckley et al ., Heart, 2013

  12. Literature Search Results

  13. Alternative Models of CR Delivery • Low-cost, accessible models: • Home-based (Dalaletal., 2010) • Community-based (Mandic et al., 2013) • Use of technology (evidence lacking, weak) • Internet-based (Munro et al., 2013) • telehealth, and mobile (Beatty et al., 2013)

  14. Implementation Considerations • Developing national policies support CR provision • Randomized controlled trials of CR in LMICs • Provide cost-effectiveness data • CR part of integrated cardiology service • Expanding health human resources & service delivery • Integration of CR in the curricula of medical schools • Training of healthcare professionals (“Task-shifting”) • Increasing the hours of operation of existing programs

  15. Next Steps • Literature review • Writing • 2ndary Panel review, revision • Submission to Nature Reviews: Cardiology • WCC 2016 – launch? • Field and feasibility testing in low-resource settings

  16. Acknowledgments • Lit search: Maureen Pakosh, MIst • Nizal Sarrafzadegan, MD (co-chair) • Contact: sgrace@yorku.ca • Funding:

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