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Cardiac Rehabilitation Dose Around the World: Variation and Correlates. Circ Cardiovasc Qual Outcomes 2020 01;13(1):e005453



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BACKGROUND: Cardiac rehabilitation (CR) is recommended in clinical practice guidelines, but dose prescribed varies highly by country. This study characterized the dose offered in supervised CR programs and alternative models worldwide and their potential correlates.

METHODS AND RESULTS: In this cross-sectional study, an online survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Countries were classified based on region and income categories. Dose was operationalized as program duration×sessions per week. Generalized linear mixed models were performed to assess correlates. Of 203 countries in the world, 111 (54.7%) offered CR; data were collected in 93 (83.8% country response rate; n=1082 surveys, 32.1% program response rate). Globally, supervised CR programs were a median of 24 sessions (n=619, 57.3% programs ≥12 sessions); home-based and community-based programs offered 6 and 20 sessions, respectively. There was significant variation in supervised CR dose by region (P≤0.001), with the Americas (median, 36 sessions) offering a significantly greater dose than several other regions; there was also a trend for variation by country income classification. There was no difference in home-based dose by region (P=0.43) but there was for community-based programs (P<0.05; Americas offering greater dose). There was a significant dose variation in both home- and community-based programs by income classification (P=0.002 and P<0.001, respectively), with higher doses offered by upper-middle-income than high-income countries. Correlates of supervised CR dose included more involvement of physicians (P=0.026), proximity to other programs (P=0.002), and accepting patients with noncardiac indications (P=0.037).

CONCLUSIONS: CR programs in many countries may need to increase their dose, which could be supported through physician champions.

Author List

Chaves G, Turk-Adawi K, Supervia M, Santiago de Araújo Pio C, Abu-Jeish AH, Mamataz T, Tarima S, Lopez Jimenez F, Grace SL


Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiac Rehabilitation
Community Health Services
Cross-Sectional Studies
Exercise Therapy
Global Health
Health Care Surveys
Healthcare Disparities
Heart Diseases
Home Care Services
Socioeconomic Factors
Time Factors
Treatment Outcome
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