Status of cardiac rehabilitation services in low- and middle-income countries

Abstract

Purpose: Despite the benefits of cardiac rehabilitation (CR), there is lack of data on the availability, characteristics, and barriers to feasible CR services in low- and middle-income countries (LMIC). The objectives of this study were to assess the availability and characteristics of CR services and identify barriers to CR implementation and participation in LMIC. Methods: Sixty national cardiac societies, heart associations, and heart foundations and 100 cardiac specialists from LMIC throughout the World Health Organization regions were asked whether CR services were provided to adult cardiac patients at any institute in their countries. Responses were received from 40 LMIC. Of these, cardiac specialists from 23 countries that offered CR services completed a questionnaire which examined the characteristics of the CR services provided by the facility, patients' barriers to CR participation, and approaches that could transcend barriers to participation in CR. Cardiac specialists from 10 countries that did not offer CR services completed another questionnaire which assessed barriers to successful implementation of a CR programme and feasible components for sustainable CR. Results: CR services were available in 26 LMIC (questionnaire non-response=3 LMIC). CR components included exercise training (100%), healthy diet advice (100%), psychological support (95.7%), and smoking cessation (91.3%). Funding sources to operate the CR programmes were private insurance (4.5%), private (40.9%), central government (50.0%), and mixed (22.7%). Cardiac specialists reported <<distance to the facility,>> <<costs,>> and as the leading barriers for CR participation for patients. Many of the respondents (68.2%) were in favour of a decentralized health care system and listed automatic referral and increasing cardiac specialists' and patients' knowledge regarding CR to transcend barriers. CR services were not available in 14 LMIC (questionnaire non-response=4 LMIC). The most endorsed barriers for successful implementation of a CR programme were <<lack of economic resources,>> <<lack of qualified personnel,>> <<lack of equipment,>> and <<rehabilitation is not supported by health policies.>> Cardiac specialists listed patient education, smoking cessation, and counselling regarding medications and diet as feasible components for sustainable CR in these countries. Conclusion: The results suggest the need to increase the availability and accessibility of cost-effective and feasible CR services in low-resource settings to assist in reducing the rate of premature mortality in patients with heart disease.