Cardiac Rehabilitation Delivery in Low and Middle-Income Countries

Cardiovascular diseases are among the leading causes of disability in low- and middle-income countries (LMICs). Cardiac rehabilitation (CR) is an effective secondary prevention program model. In this cross-sectional study, a confidential, online surveywas administered to CR programs around the world. CR programs were identified in 55/138 (39.9%) LMICs; 47 (85.5% country response rate) countries participated and 335(53.5% program response rate) surveys were initiated. There was 1 CR spot for every66 incident ischemic heart disease patients in LMICs. CR was most often paid by patients in LMICs (n=212,65.0%). On average, programs offered 7.31.8/11 core components over 33.730.7 sessions (significantly greater in publicly-funded programs;p<.001). Lack of patient referral (3.8/5) and financial resources (3.5/5) were the greatest barriers to CR provision in LMICs. CR is only available in 40% of LMICs, but where offered is fairly consistent with CR guidelines. Governments must enact policies to reimburse CR so patients do notCardiovascular diseases are among the leading causes of disability in low- and middle-income countries (LMICs). Cardiac rehabilitation (CR) is an effective secondary prevention program model. In this cross-sectional study, a confidential, online surveywas administered to CR programs around the world. CR programs were identified in 55/138 (39.9%) LMICs; 47 (85.5% country response rate) countries participated and 335(53.5% program response rate) surveys were initiated. There was 1 CR spot for every66 incident ischemic heart disease patients in LMICs. CR was most often paid by patients in LMICs (n=212,65.0%). On average, programs offered 7.31.8/11 core components over 33.730.7 sessions (significantly greater in publicly-funded programs;p<.001). Lack of patient referral (3.8/5) and financial resources (3.5/5) were the greatest barriers to CR provision in LMICs. CR is only available in 40% of LMICs, but where offered is fairly consistent with CR guidelines. Governments must enact policies to reimburse CR so patients do not pay out-of-pocket.