Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison

• Published in: The American heart journal Vol. 240; pp. 16 - 27
• Main Authors: Chacin-Suarez, Audry, Grace, Sherry L., Anchique-Santos, Claudia, Supervia, Marta, Turk-Adawi, Karam, Britto, Raquel R., Scantlebury, Dawn C., Araya-Ramirez, Felipe, Gonzalez, Graciela, Benaim, Briseida, Fernandez, Rosalia, Hol, Jacqueline, Burdiat, Gerard, Salmon, Richard, Lomeli, Hermes, Mamataz, Taslima, Medina-Inojosa, Jose R., Lopez-Jimenez, Francisco
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01-10-2021; Elsevier Limited
• Subjects: Availability; Cardiovascular disease; Cardiovascular diseases; Coronary artery disease; Heart diseases; Ischemia; Rehabilitation; Response rates; Teams; Guatemala; Dominican Republic; Brazil; Mexico; Caribbean area; Latin America; HICs; LMICs; IHD; CVDs; CR; LAC
• DOI: 10.1016/j.ahj.2021.05.010
• EISSN: 1097-6744
• ISSN: 0002-8703

-In Latin American and Caribbean (LAC) 30% of countries have no CR.-LAC show limited CR capacity in relation to need; 1.3 million spots/year needed.-There is only 1 CR spot for every 24-incident ischemic heart disease patient/year.-CR services are often not covered, leaving many patients paying out-of-pocket.-While CR dose is robust, LAC programs are less comprehensive than those globally.
This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent.
In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study.
≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01).
In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.
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