Cardiac Rehabilitation Availability and Delivery in Canada: How does it Compare to other High-Income Countries?

Abstract

Background: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity and density, as well as (2) the nature of programs, and (3) compare these by (a) province/territory and (b) to other high-income countries(HICs). Methods: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada’s Chronic Disease Surveillance System ischemic heart disease (IHD) incidence estimates. Twenty-eight HICs with CR were selected for comparison(N=619programs), and multi-level analyses performed. Results: CR was available in 10/13(76.9%)provinces(no programs in Canada’s North), with 74 of182 programs initiating a survey (40.7%response).Program volumes (median=250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55IHD patients nationally(similar in other HICs), and 186,187more spots are needed annually. Most programs were funded by government/hospital sources (n=48, 66.7%), but in 23(31.5%) patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in over 90% of programs. Programs had a multidisciplinary team of 6.2±2.1staff, offering 7.7±1.5/10 core components (varied by province, p=0.001; return-to-work offered less frequently than other HICs; p=0.03), over 42.0±26.0hours (provincial and other HIC differences, p<.001). Conclusion: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.