Advocacy for outpatient cardiac rehabilitation globally.
Cardiovascular diseases (CVD) are the leading cause of death globally. Cardiac rehabilitation (CR) is an evidence-based intervention recommended for patients with CVD, to prevent recurrent events and to improve quality of life. However, despite the proven benefits, only a small percentage of those would benefit from CR actually receive it worldwide. This paper by the International Council of Cardiovascular Prevention and Rehabilitation forwards the groundwork for successful CR advocacy to achieve broader reimbursement, and hence implementation.



First, the results of the International Council's survey on national CR reimbursement policies by government and insurance companies are summarized. Second, a multi-faceted approach to CR advocacy is forwarded. Finally, as per the advocacy recommendations, the economic impact of CVD and the corresponding benefits of CR and its cost-effectiveness are summarized. This provides the case for CR reimbursement advocacy.



Thirty-one responses were received, from 25 different countries: 18 (58.1 %) were from high-income countries, 10 (32.4 %) from upper middle-income, and 3 (9.9 %) from lower middle-income countries. When asked who reimburses at least some portion of CR services in their country, 19 (61.3 %) reported the government, 17 (54.8 %) reported patients pay out-of-pocket, 16 (51.6 %) reported insurance companies, 12 (38.7 %) reported that it is shared between the patient and another source, and 7 (22.6 %) reported another source.



Many patients pay out-of-pocket for CR. CR reimbursement around the world is inconsistent and insufficient. Advocacy campaigns forwarding the CR cause, supported by the relevant literature, enlisting sources of support in a unified manner with an organized plan, are needed, and must be pursued persistently.
Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, 576104, Karnataka, India.
Abraham Samuel
AS
Babu
Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Francisco
F
Lopez-Jimenez
Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Randal J
RJ
Thomas
Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1 W8, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7, ON, Canada.
Wanrudee
W
Isaranuwatchai
Institute of Cardiology of Santa Catarina, Universidade e do Sul de Santa Catarina, Palhoça, Brazil.
Artur Haddad
AH
Herdy
Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1 W8, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7, ON, Canada.
Jeffrey S
JS
Hoch
School of Kinesiology and Health Science, York University, Bethune 368, York University, 4700 Keele Street, Toronto, M3J 1P3, ON, Canada. sgrace@yorku.ca.|Toronto Western Hospital, GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, ON, Canada. sgrace@yorku.ca.
Sherry L
SL
Grace
D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D000072038:Cardiac Rehabilitation / Q000191:economics / Q000379:methods*; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D003906:Developing Countries; D014943:Global Health; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health; D008297:Male; D010045:Outpatients; D010344:Patient Advocacy; D011203:Poverty / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012051:Reimbursement Mechanisms
Cardiac rehabilitation; Cardiovascular disease; Insurance; Reimbursement