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Cardiovascular disease (CVD) is the leading cause of death worldwide. Advancements in acute CVD treatments have resulted in high prevalence of patients living with CVD who are at high risk of recurrence and mortality. This burden of CVD has been great in high-income countries for decades, and is now reaching epidemic proportions in low and middle-income countries (LMICs).
Cardiac rehabilitation (CR) is an outpatient model of chronic disease management for secondary CVD prevention. Robust evidence demonstrates that CR participation reduces mortality by 25%, morbidity and CVD risk factors and improves quality of life, all in a cost-effective manner.1 Hence, CR serves as a key tool in addressing the global burden of CVD.
Despite clinical practice guideline recommendations for CR, it is underused globally. The reasons for CR underuse are well known, and include factors from the patient-level through to the healthcare system writ large. Arguably, the most important factors explaining CR underutilisation are geographic access, cost, patient time conflicts during work hours due to role obligations, and lack of awareness regarding the nature of CR and the associated benefits. To overcome these barriers, alternative models of CR delivery have been developed—most notably home-based CR. Home-based CR involves delivery of all the core components of traditional CR; however, patients are supported in their education and are provided counselling over the phone, and they engage in their prescribed exercise in an unsupervised setting. Participation in home-based CR is associated with equivalent benefits to supervised programmes in a cost-effective manner. With advances in technology, hybrid home-based programmes have been developed, incorporating email communication between patients and CR providers, telehealth videoconferencing with remote patients, and logging of physical activity on secure CR websites, for example.
Most recently, CR has been delivered via mobile phones. Indeed, the article by Varnfield et al2 describes …