Cardiac Rehab Resources Lacking

Sherry Grace, PhD

There is only one cardiac rehab spot for every 12 patients that need it to prevent another heart event around the world, according to new research.

Cardiac rehab-a program of structured exercise, education, and counseling-is only available in half of the countries in the world, according to a first-ever global audit and survey of cardiac rehab conducted in York University's Faculty of Health, Toronto, Ontario, Canada.

The programs that do exist can only serve 1.65 million patients, leaving a gap of over 18 million patients in need each year. Africa, China, India, and Russia, where heart disease burden is rising the fastest, are shown to have the least cardiac rehab capacity, according to the studies.

“The programs that are available, no matter where in the world, are quite consistent in delivery and of high quality however,” says Sherry Grace, PhD, professor at York University and senior scientist at University Health Network, who is senior investigator of the studies published in EClinicalMedicine. “Where they are lacking, it seems that programs are insufficiently resourced to offer tobacco cessation interventions, psychosocial management, as well as return-to-work counseling as part of their program. These are key, just like exercise, in reducing rates of repeat events and death in heart patients.”

Given participation in these programs results in 20% less death, many people are dying unnecessarily around the world, according to Grace. “We are also wasting precious healthcare dollars when patients do not access cardiac rehab,” she says.

This audit and survey were undertaken through the International Council of Cardiovascular Prevention and Rehabilitation.

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“No one had ever gone out and actively determined where cardiac rehab existed in the world,” says Grace. “We knew there was grossly insufficient capacity, but for the first time ever, we are able to quantify what the exact need is in relation to burden of heart disease for every country in the world.”

“We also knew what was delivered in cardiac rehab programs in only 40% of countries thought to offer it, and even so, we could not compare what was delivered in one country to another. We wanted to determine to what degree programs were offering services in line with internationally agreed standards,” she says. 

Healthcare executives are responsible to ensure cardiac patients are offered cardiac rehab as part of the continuum of care, as per clinical practice guidelines from the American Heart Association, according to Grace.

“Healthcare executives must support and resource cardiac rehab programs in their institutions that offer cardiac care-including acute-so all discharged heart attack patients receive these proven programs,” Grace says.  

Moreover, executives must ensure that they provide support and fully resource cardiac rehab programs at their organizations so they are fully comprehensive. In addition, ensuring a multidisciplinary team, including individuals with expertise in each of the areas of secondary prevention (i.e., tobacco cessation, medical risk factor management, diet, and mental health), is key.

Grace and her colleagues have also done work on healthcare administrators’ views on cardiac rehab, and how important it is that they support and promote it.