Elsevier

American Heart Journal

Volume 158, Issue 3, September 2009, Pages 480-487
American Heart Journal

Clinical Investigation
Prevention and Rehabilitation
Current status of cardiac rehabilitation in Latin America and the Caribbean

https://doi.org/10.1016/j.ahj.2009.06.020Get rights and content

Background

The prevalence of coronary artery disease (CAD) in Latin America is increasing and contributes importantly to the global burden of cardiovascular diseases. Advanced resources for the diagnosis and treatment of CAD are available in most of the region. However, preventive approaches such as cardiovascular rehabilitation programs (CVRP) may not be widely implemented.

Methods

We carried out a telephone-based survey to hospitals sampled in a random and population-weighted fashion from a list of 202 centers with cardiac catheterization laboratories in Mexico, Central and South America, and the Caribbean. We collected information of availability of cardiac procedures and imaging techniques and also extensive data about the presence, characteristics, and quality measures of CVRP.

Results

A total of 98 centers were contacted, and a complete survey was provided by 59 centers (60%) from 13 countries. Cardiovascular rehabilitation programs were available in only 56% of centers. There were no differences between centers with and without CVRP regarding type of hospital, availability of cardiac surgery, and annual volume of patients with myocardial infarction. Among centers with CVRP, 70% offered all phases of CVRP. The lack of CVRP was attributed to lack of qualified personnel in 41% of centers, financial constraints in 33%, and lack of physical space in 13%. All centers without CVRP performed cardiac surgery and percutaneous interventions.

Conclusions

Despite the presence of state-of-the-art technology for the diagnosis and treatment of CAD, availability of CVRP, a less expensive yet effective tool for the treatment of CAD, appears to be limited in Latin America and the Caribbean.

Section snippets

Methods

We identified health care facilities that offer cardiac catheterization in Mexico, Central and South America, and the Caribbean. We carried out a telephone-based survey on the availability and characteristics of CVRP.

Results

A total of 98 centers were initially contacted. Surveys were completed by 59 centers (60%) from 13 countries (Figure 1). The population-weighted sample per country was reached for all countries except Brazil, where the quota was not met because only 4 out of 31 centers (12%) returned completed questionnaires, and Cuba, where no contacts where made. Most of the questionnaires were filled by telephone (n = 53, 90%). Few centers (n = 6, 10%) were not available after 3 phone call attempts; their

Discussion

The results of this survey provide data to support the hypothesis that the availability of CVRP in Latin America is very limited and less than the availability of other advanced and more expensive cardiac services. To the best of our knowledge, this is the first survey assessing the availability and characteristics of CVRP services in Latin America. Less than 60% of the surveyed hospitals that treat acute cardiac patients in Latin America offer CVRP. The study also demonstrates that, in Latin

Conclusion

Despite plentiful evidence of the benefits of CVRP after a cardiac event, the availability and implementation of CVRP in Latin America is limited. Lack of referral, cost concerns, limitations in the availability of trained personnel and space, and the misperception that CVRP lacks significant benefits, are some of the barriers that appear to explain the low availability and underuse of CVRP in Latin America. Strategies to increase the availability and application of CVRP in Latin America are

Acknowledgements

We would like to acknowledge the help of Dr Hermes Ilarraza-Lomelí, Director of Cardiovascular Rehabilitation at Instituto Nacional de Cardiología Ignacio Chavéz for his assistance with this study.

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