Britto, Raquel Rodrigues

Abstract Background Cardiac rehabilitation (CR) is an established model of cardiovascular (CV) prevention that has proven benefits. Availability, characteristics and need of CR programs in Latin-American and Caribbean (LAC) countries remains poorly characterized. This study aims to establish the availability, capacity, density and aspects of CR delivery in LAC. Methods A cross-sectional survey was administered to CR programs in 24 LAC. Local CV organizations and societies identified CR programs. Characteristics of individual CR program were reviewed including: funding sources, core components, healthcare providers, and dose (number of sessions per weeks X total number of weeks) of CR. National CR capacity (median number of patients a program could serve per year X number of programs per country), density (Ischemic Heart Disease [IHD] incidence per year/ national capacity), need (IHD incidence per year- national capacity) and occupancy (median number patients program served per year/national capacity) were computed based on survey responses. Results At least one CR program was identified per LAC country (total 255 programs across 24 countries). Data was collected in 20 of the 24 countries. Responses were received from 139/255 programs (median program response rate=55%; Table 1). Over 50% (n=73) of programs were funded by multiple sources (government, hospital/clinic, private health insurance); Self-payment was reported by 63% programs, in which 24 (33.8%) patients paid over 50% of the cost. Guideline-indicated conditions were accepted in 77% or more programs. Physiotherapists (n=106, 76.3%), cardiologists (n=105, 75.5%) and dietitians (n=79, 56.8%) were the most common healthcare providers on CR teams. Regionally, programs offered 9 (IQR = 8–10) core components (patient education, exercise prescription and initial assessment delivered by nearly all programs). Median CR was 36 (IQR = 24–56) sessions/patient. Twenty-seven (20.9%) programs offered alternative CR models (e.g., home or community-based and hybrid models). Median national capacity was 500 CR spots/country (IQR= 200–2300). Regional density was 1 CR spot per 24 incident IHD patients per year. Greatest need in absolute terms for CR was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed per year to manage incident IHD patients; Table 1). Occupancy ranged from over 100% in Colombia to 15% in Chile (median=60%, IQR = 32%–81%), Table 1. Conclusion In LAC countries, there is very limited capacity to meet the need for CR. Nature of CR services varied regionally. Funding Acknowledgement Type of funding source: None

Objective Cardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source. Methods A cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed. Results CR was identified in 55/138 (39.9%) LMICs; 47/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; p<0.001). Over 85% of programmes accepted guideline-indicated patients. Cardiologists (n=266, 89.3%), nurses (n=234, 79.6%; vs 544, 91.7% in HICs, p=0.001) and physiotherapists (n=233, 78.7%) were the most common providers on CR teams (mean=5.8±2.8/programme). Programmes offered 7.3±1.8/10 core components (vs 7.9±1.7 in HICs, p<0.01) over 33.7±30.7 sessions (significantly greater in publicly funded programmes; p<0.001). Publicly funded programmes were more likely to have social workers and psychologists on staff, and to offer tobacco cessation and psychosocial counselling. Conclusion CR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.