This informal CPD article on Increasing Delivery and Patient Participation in Cardiac Rehabilitation to Save Lives was provided by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), a non-profit organization that is dedicated to promoting cardiovascular disease prevention and rehabilitation globally.
What is Cardiac Rehabilitation?
Cardiovascular diseases (CVD) are among the leading burdens of disease and causes of disability globally, with particular burden in low and middle-income countries. It is a chronic condition, with patients at risk of recurrent events and death if they do not engage in recommended actions to reduce their risk.
Cardiac rehabilitation (CR) is a comprehensive model of care that has been shown to mitigate this burden. Participation results in 20% lower death as well as significantly improved quality of life. Based on the abundant evidence on its benefits, CR is highly recommended for patients in cardiovascular clinical practice guidelines globally.
Availability of Cardiac Rehabilitation Globally
Unfortunately, research by ICCPR shows that CR is only available in half of countries in the world. Based on burden of disease and program availability data, Africa and the Eastern Mediterranean are the regions in the greatest need of more CR programs; at a national-level, India and China each need over 3 million additional CR spots per year to treat all new CVD cases, with Russia not far behind.
Reasons for the lack of CR have been studied extensively, with one of the key reasons being lack of trained healthcare providers to deliver it. Moreover, without programs to refer to, healthcare providers are not referring their patients to these life-saving programs, despite guideline recommendations to do so.
Increasing CR Delivery
ICCPR developed an evidence-based consensus statement on how to feasibly and affordably deliver CR in low-resource settings. To facilitate application of its recommendations, they also developed a corresponding educational program on how to deliver each component of CR – the Cardiovascular Rehabilitation Foundations Certification (CRFC) program.
This evidence-based program is intended for healthcare professionals (including trainees) from any discipline involved in the delivery of CR, and is delivered entirely online. It covers patient assessment, exercise training, dietary counseling, tobacco cessation, risk factor management (lipids, blood pressure, weight, diabetes), psychosocial health, patient education and counselling, and alternative delivery settings. Ultimately, the goal of the CRFC program is to augment capacity for CR delivery around the globe. Over 1,000 physicians from India have already taken the course, and rated it very highly.
Promoting Patient Participation in CR
Even where CR programs are available, utilization is sub-optimal. While reasons are multi-factorial, chiefly this is due to the fact that indicated patients are insufficiently referred to CR.
Interventions that aim to increase patient utilization of CR have been identified. The ICCPR developed a position statement on this, and based on evidence recommended that to increase use, healthcare providers should promote CR to patients face-to-face at the bedside before they leave hospital for a heart problem. Their encouragement results in up to 8 times more patient enrolment.
Accordingly, to implement this recommendation, an online learning module was developed for inpatient healthcare providers on how and why to encourage CR participation to indicated patients. It is also available in French and Portuguese, with Spanish and Chinese translations forthcoming. This brief, evidence-based module emphasizes the importance and benefits of CR, as well as educates providers on recognizing patients who should be encouraged to enroll, and how to provide strong CR endorsement. By ensuring more CR capacity, and that patients engage in these programs, we can save many lives.
We hope this article was helpful. For more information from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), please visit their CPD Member Directory page. Alternatively please visit the CPD Industry Hubs for more CPD articles, courses and events relevant to your Continuing Professional Development requirements.
