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Cardiac rehabilitation in low-resource settings and beyond: the art of the possible
  1. Pedro Ordunez
  1. Correspondence to Dr Pedro Ordunez, Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd Street, NW, Washington DC 20037, USA; ordunezp{at}

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Cardiovascular disease (CVD) is the largest epidemic that humankind has confronted. Annually CVD is responsible for one-third of all deaths worldwide (17.2 out of 54.8 million deaths). Eighty per cent of deaths due to CVD are caused by two atherosclerotic conditions: ischaemic heart disease (8.1 million) and cerebrovascular disease (6.4 million). They in turn are the first and third causes, respectively, of global years of life lost.1 The severity of the CVD epidemic in terms of lives lost and economic cost worldwide is paralleled by the enormous challenges (quality of life, disabilities, family impact, economic burden) faced by those who survive an acute cardiovascular event. The scenario is even more dire in low- and middle-income countries (LMIC) accounting for >80% of the CVD global burden1 and where the care gap, between the evidence-based guidelines and the implementation, is enormous.

The efficacy of cardiac rehabilitation (CR) in atherosclerotic CVD secondary prevention is well established. The objective of CR is to stabilise, slow or even reverse the progression of CVD, which in turn reduces the risk of a future cardiac event. CR is an ambitious and comprehensive set of interventions that include patient assessment, nutritional and physical activity counselling, intensive management of lipids, hypertension, weight and diabetes mellitus, tobacco cessation, psychosocial management and exercise training.2 Undoubtedly, CR, always part of the cardiology conversation, can play a central role in the mitigation of the CVD epidemic worldwide.

Given the documented benefits of CR and its low accessibility in LMIC, proposing a feasible model of CR delivery and implementation in resource-constrained settings becomes a pressing public health issue. In fact, since the 1993 WHO publication of its visionary report on Rehabilitation after Cardiovascular Diseases, with Special Emphasis on Developing Countries,3 no updated statement on the appropriate CR model for …

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  • Contributors PO: complete contributions to the conception and design of the work, and the acquisition, analysis and interpretation of data. Drafting the work and revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Disclaimer The opinions expressed in this commissioned editorial are solely responsibility of the author and do not necessarily reflect the views of the Pan American Health Organization.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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