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Simplified Strategies of CR in Low-Resource Settings:

Perspectives from ICCPR

Sherry L. Grace, PhDSecretary/Treasurer, ICCPR

Full Professor, York UniversityDirector of Research, Cardiac Rehab

University Health Network

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Disclosure Statement of Financial Interest

I, Sherry Grace DO NOT have a financial interest/arrangement or affiliation with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

3WHO Global Atlas CVD Prev & Control,2011

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Availability of CR Globally

Adawi et al., (accepted in principle) Nature Reviews:

Cardiology

Global Availability of CR by Country Income Classification

High-income countries: 68.0% (51/75 countries)

Middle-income countries: 28.2% (29/103 countries)

Low-income countries: 8.3% (3/36 countries)

Globally: 38.8%   (83/214 countries)

LMICs: 23.0%

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Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (accepted in principle). Nature Reviews: Cardiology.

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21 Associations of the

7 1993

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• “define health system-related opportunities … to access for … rehabilitation … and develop feasible and integrated approaches to apply cost-effective NCD interventions at all levels of health care”

2011; p. 46

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CR delivery model for low-resource settings: A consensus statement

• Primary Writing Panel• Grace, S.L., Turk-Adawi, K., Contractor, A., Atrey, A.,

Campbell, N., Derman, W., Ghisi, G.M.G., Hu, D., Lopez, F., Mendis, S.,(WHO) & Sarrafzadegan, N.

• Secondary Writing Panel• Buckley, J., Akinroye, K. (WHF), Mola, A., Neubeck,

L., Pogosova, N., & Rivas-Estany, E.

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Literature Review: Search Strategy

1. Comprehensive search using Medline and Embase

a- cardiac diseases

b- rehabilitation

c- LMICs

2. Grey literature search for reports, guidelines

11Buckley et al ., Heart, 2013

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Literature Search Results

Component # citations

CR in LMICs 1417

CR models 130

Psychological therapy  566

Obesity 295

Lipids 152

Blood pressure 215

Education interventions  318

Smoking cessation  237

Nutrition interventions 274

Alternative Models of CR Delivery

Low-cost, accessible models:Home-based (Dalal etal., 2010) Community-based (Mandic et al., 2013)

Use of technology (evidence lacking, weak)Internet-based (Munro et al., 2013)

telehealth, and mobile (Beatty et al., 2013)

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Developing national policies support CR provision

Randomized controlled trials of CR in LMICs

Provide cost-effectiveness data CR part of integrated cardiology service

Expanding health human resources & service delivery

Integration of CR in the curricula of medical schools

Training of healthcare professionals (“Task-shifting”)

Increasing the hours of operation of existing programs

Implementation Considerations

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Next Steps

• Literature review• Writing• 2ndary Panel review, revision• Submission to Nature Reviews:

Cardiology• WCC 2016 – launch?• Field and feasibility testing in low-resource

settings

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Acknowledgments

• Lit search: Maureen Pakosh, MIst

• Nizal Sarrafzadegan, MD (co-chair)

• Contact: sgrace@yorku.ca

• Funding: