Cardiac rehabilitation delivery model for low-resource settings

Objective: Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.

Methods: A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (i.e., physical activity, diet, tobacco, and mental health), (2) medical risk factor management (e.g., lipid control, blood pressure control), (3) education for self-management; and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.

Results: Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in lowresource settings were summarized in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by nonphysician healthcare workers, in non-clinical settings.

Conclusions: Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.