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Item Open Access Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A global comparison(American Heart Journal, 2021-10) Chacin-Suarez, Audry; Grace, Sherry; Anchique-Santos, Claudia; Supervia, Marta; Turk-Adawi, Karam; Britto, Raquel ; Scantlebury, Dawn; Araya-Ramirez, Felipe; GONZALEZ, GRACIELA; Benaim, Briseida; Fernandez, Rosalia; Hol, Jacqueline; Burdiat, Gerard; SALMON, RICHARD; Lomeli, Hermes; Mamataz, Taslima; Medina-Inojosa, Jose; Lopez Jimenez, FranciscoBackground: 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. Methods: 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. Results: ≥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). Conclusion: 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.Item Open Access Cardiac Rehabilitation Following Acute Coronary Syndrome in Women(Springer, 2017-06-17) Bennett, Amanda L.; Lavie, Carl; Grace, SherryOpinion statement Acute coronary syndrome (ACS) is among the leading burdens of disease among women. It is a significant driver of morbidity and chronically undermines their quality of life. Cardiac rehabilitation (CR) is indicated for ACS patients in clinical practice guidelines, including those specifically for women. CR is a multi-component model of care, proven to reduce mortality and morbidity, including in women. However, women are significantly less likely to be referred to CR by providers, and if they are referred, to enroll and adhere to programs. Reasons include lack of physician encouragement, preference not to feel fatigue and pain, transportation barriers, comorbidities and caregiving obligations. Strategies to mitigate this under-use include systematic early inpatient referral, tailoring programs to meet women’sneedsand preferences (e.g., offering dance, opportunities for social interaction), and offering nonsupervised delivery models. Unfortunately, these strategies are not widely available to women. Given the greater longevity seen in women, the critical role CR plays in augmenting quality of life in this population must be recognized and care providers must do more to facilitate referral to and encourage participating in CR programs.Item Open Access Profile of women choosing mixed-sex women-only, and home-based cardiac rehabilitation models and impact on utilization(The Journal of Women and Health, 2022-01-04) Heald, Fiorella A.; Marzolini, Susan; Colella, Tracey JF; Oh, Paul; Nijhawan, Rajni; Grace, SherryThis study compared characteristics and program utilization in women electing to participate in mixed-sex, women-only, or home-based cardiac rehabilitation (CR). In this retrospective cohort study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017-February 2020 were analyzed. There were 727 women (74.7% mixed, 22.0% women-only, 3.3% home-based) who initiated CR. There were significantly more women who were not working in women-only than mixed-sex (80.4% vs 64.1%; P=.009). Session adherence was significantly greater with mixed-sex (58.8±28.9% sessions attended/25) than women-only (54.3±26.3% sessions attended/25; P=.046); program completion was significantly lower with home-based (33.3%) than either supervised model (59.7%; P=.035). Participation in women-only CR may be less accessible. Further research is needed to investigate offering remote women-focused sessions or peer support.