title: Cardiac rehabilitation services in low- and middle-income countries: a scoping review.
abstract: BACKGROUND
  Despite the decreasing rate of cardiovascular disease-related mortality in developed nations, low- and middle-income countries (LMICs) are experiencing an increase. Cardiac rehabilitation (CR) successfully addresses this burden; however, the availability and nature of CR service delivery in LMICs are not well known.
  
  
  OBJECTIVE
  This scoping review examined the (1) presence and accessibility of CR services, (2) structure of CR services, and (3) effects of CR on patient outcomes in LMICs.
  
  
  METHODS
  Search criteria consisted of (1) nations considered to be low- or middle-income according to World Bank criteria, (2) CR, defined as programs including exercise and education, and (3) adults with cardiovascular diseases. Literature was identified through searching (a) the MEDLINE and EMBASE electronic databases, (b) proceedings from international cardiac conferences, (c) the grey literature and (d) through consulting experts in the field.
  
  
  RESULTS
  Thirty peer-reviewed publications were identified. Grey literature, including Web sites for individual CR programs, revealed that CR is available in 32 (22.1%) LMICs. The most comprehensive data on accessibility stem from Latin America and the Caribbean, where 56% of institutions with cardiac catheterization facilities offered CR. Literature showed that some programs offered exercise, dietary advice, education, and psychological support, to assist patients to resume work and other activities of daily living. Fifteen peer-reviewed studies reported on CR outcomes, most of which were positive.
  
  
  CONCLUSIONS
  Although patients similarly benefit from CR, few programs are available in LMICs. Policies need to be implemented to increase provision of tailored CR models at the global and national level, with evaluation.
authors.affiliation: Shamila Shanmugasegaram, MSc Graduate Student, School of Kinesiology and Health Science, York University, Toronto, Canada. Carmen Perez-Terzic, MD, PhD Chair, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota. Xiaolian Jiang, PhDProfessor, West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. Sherry L. Grace, PhD Associate Professor, School of Kinesiology and Health Science, York University, and Director of Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
authors.forename: Shamila
authors.initials: S
authors.lastname: Shanmugasegaram
authors.forename: Carmen
authors.initials: C
authors.lastname: Perez-Terzic
authors.forename: Xiaolian
authors.initials: X
authors.lastname: Jiang
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D017691:Caribbean Region; D003906:Developing Countries; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000534:rehabilitation*; D007843:Latin America; D011203:Poverty