Availability and Delivery of Cardiac Rehabilitation in the Eastern Mediterranean Region: How Does it Compare Globally?

Background: This study aimed to (1) confirm cardiac rehabilitation (CR)availability, establish (2) CR density and unmet need, as well as (2) the nature of programs, and (3) compare these by (a) EMR country and (b) to other countries. Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates. Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year(versus 12globally). One-third of programs were privately funded (n=8; versus globally p<.001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n=378, 36.3% globally; p<.001). Over 80% of programs accepted guideline-indicated patients. Nurses (n=20, 95.2%), cardiologists (n=18, 85.7%) and dietitians (n=18, 85.7%) were the most common healthcare providers on the CR team (mean=6.4±2.2/program; 5.9±2.8 globally, p=.18). On average, programs offered 8.9±1.7/11 core components (versus 8.7±1.9 globally, p=.90). These were most commonly initial assessment, management of risk factors, and patient education (n=21, 100.0% for each), and least commonly return-to-work counselling (n=1571.4%). Mean dose was 27.0±13.5 sessions (versus 28.7±27.6 globally, p=.38).Seven (33.3%) programs offered some alternative models. Conclusion: CR is insufficiently implemented, with 2,079,283 more spots needed/year across the EMR. But where offered, CR is consistent with guidelines.