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Heartbeat: Cardiac rehabilitation in low-resource settings
  1. Catherine M Otto
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Cardiac rehabilitation (CR) is an efficacious and cost-effective intervention in adults with cardiovascular disease in developed countries. The essential elements of CR fall into 4 domains: risk factor management via lifestyle changes such as exercise, diet, and smoking cessation; secondary preventative therapies including lipid-lowering and blood pressure medications; education to improve self-management by patients; and assistance in returning to work. However, CR remains underutilized, even in high-income countries, and there are significant barriers to providing traditional health-care system based CR in low resource settings.

In this issue of Heart, a consensus statement on approaches to CR in low-resource settings is presented by an expert panel using a structured development process based on a systematic literature review (see page 1449). The panel was selected by the International Council on Cardiovascular Prevention and Rehabilitation (ICCPF) and included authors from several countries—Canada, China, India, Iran, Singapore, South Africa, the UK and USA. A detailed table presents 10 specific CR recommendations that can be implemented in any setting, with a modified GRADE level of evidence or indication that this is a consensus based recommendation. There is a detailed discussion of approaches to affordable exercise training.

As Ordunez comments in an editorial (see page 1425): “Clearly, neither CR nor other similar interventions will completely stop the CVD epidemic, but they can contribute to mitigating its consequences and thus saving many lives”. However, “Even when we concur about the reach and comprehensiveness of CR as proposed in its foundational principles, we know that implementation …

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