Cardiac rehabilitation delivery model for low-resource settings

Abstract

Objective: Cardio vascular 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 cardio vascular 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 test able 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) life style risk factor management (i.e.,physical activity, diet, tobacco, and mental health),(2) medical risk factor management (e.g., lipid control, blood pressure control), (3) education for self-management; and (4) return to work, inlow-resource settings was undertaken. Recommendationsweredevelopedbasedonidentifiedarticles,usingamodifiedGRADEapproachwhereevidenceinalow-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 summarized 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.