RT Journal Article
SR Electronic
T1 Cardiac rehabilitation delivery model for low-resource settings
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1449
OP 1455
DO 10.1136/heartjnl-2015-309209
VO 102
IS 18
A1 Sherry L Grace
A1 Karam I Turk-Adawi
A1 Aashish Contractor
A1 Alison Atrey
A1 Norm Campbell
A1 Wayne Derman
A1 Gabriela L Melo Ghisi
A1 Neil Oldridge
A1 Bidyut K Sarkar
A1 Tee Joo Yeo
A1 Francisco Lopez-Jimenez
A1 Shanthi Mendis
A1 Paul Oh
A1 Dayi Hu
A1 Nizal Sarrafzadegan
YR 2016
UL http://heart.bmj.com/content/102/18/1449.abstract
AB Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.Results Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.