title: Cardiac rehabilitation delivery model for low-resource settings.
abstract: Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.
  
  
  
  A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.
  
  
  
  Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.
  
  
  
  Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.
authors.affiliation: Faculty of Health, School of Kinesiology and Health Science, York University, and Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.affiliation: School of Health Policy and Management, York University, Toronto, Ontario, Canada.
authors.forename: Karam I
authors.initials: KI
authors.lastname: Turk-Adawi
authors.affiliation: Rehabilitation and Sports Medicine, Sir H. N. Reliance Foundation Hospital, Mumbai, India.
authors.forename: Aashish
authors.initials: A
authors.lastname: Contractor
authors.affiliation: Imperial College, Cambridgeshire, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Atrey
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Norm
authors.initials: N
authors.lastname: Campbell
authors.affiliation: Institute of Sport and Exercise Medicine (SEM), Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
authors.forename: Wayne
authors.initials: W
authors.lastname: Derman
authors.affiliation: Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gabriela L
authors.initials: GL
authors.lastname: Melo Ghisi
authors.affiliation: College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Oldridge
authors.affiliation: Research Division, Public Health Foundation of India, ISID Campus, New Delhi, India.
authors.forename: Bidyut K
authors.initials: BK
authors.lastname: Sarkar
authors.affiliation: Department of Cardiology, National University Heart Centre Singapore, Singapore.
authors.forename: Tee Joo
authors.initials: TJ
authors.lastname: Yeo
authors.affiliation: Cardiovascular Health Clinic and Cardiometabolic Program, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.affiliation: Chronic Diseases Prevention and Management, NCD, WHO, Geneva, Switzerland.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Mendis
authors.affiliation: UHN Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.affiliation: Heart Center, People Hospital of Peking University, Beijing, China.
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
authors.affiliation: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nizal
authors.initials: N
authors.lastname: Sarrafzadegan
mesh_terms: D000203:Activities of Daily Living; D000072038:Cardiac Rehabilitation / Q000191:economics*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D032921:Consensus; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D005081:Exercise Therapy / Q000191:economics; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D010353:Patient Education as Topic / Q000191:economics; D062707:Return to Work / Q000191:economics; D040242:Risk Reduction Behavior; D012648:Self Care / Q000191:economics