title: Global availability of cardiac rehabilitation.
abstract: Cardiovascular disease (CVD) is the most-prevalent noncommunicable disease and leading cause of death globally. Over 80% of deaths from CVD occur in low-income and middle-income countries (LMICs). To limit the socioeconomic impact of CVD, a comprehensive approach to health care is needed. Cardiac rehabilitation delivers a cost-effective and structured exercise, education, and risk reduction programme, which can reduce mortality by up to 25% in addition to improving a patient's functional capacity and lowering rehospitalization rates. Despite these benefits and recommendations in clinical practice guidelines, cardiac rehabilitation programmes are grossly under-used compared with revascularization or medical therapy for patients with CVD. Worldwide, only 38.8% of countries have cardiac rehabilitation programmes. Specifically, 68.0% of high-income and 23% of LMICs (8.3% for low-income and 28.2% for middle-income countries) offer cardiac rehabilitation programmes to patients with CVD. Cardiac rehabilitation density estimates range from one programme per 0.1 to 6.4 million inhabitants. Multilevel strategies to augment cardiac rehabilitation capacity and availability at national and international levels, such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed.
authors.affiliation: Cardiovascular Rehabilitation &Prevention, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Karam
authors.initials: K
authors.lastname: Turk-Adawi
authors.affiliation: Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Seddigheh Tahereh Research and Treatment Hospital, Khorram Ave, PO Box 81465-1148, Isfahan, Iran.
authors.forename: Nizal
authors.initials: N
authors.lastname: Sarrafzadegan
authors.affiliation: School of Kinesiology and Health Science, Bethune 368, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D009017:Morbidity; D016730:Program Development; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*