Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Samuel J. Wood Library, Weill Cornell Medical College, New York, NY, USA.
Glob Heart. 2017 Dec;12(4):323-334.e10. doi: 10.1016/j.gheart.2016.09.004. Epub 2017 Mar 13.
Cardiac rehabilitation (CR) is a cornerstone of secondary prevention of ischemic heart disease. It is critically important in low- and middle-income countries (LMIC), where the burden of ischemic heart disease is substantial and growing. However, the availability and utilization of CR in LMIC is not systematically known.
This study sought to characterize the availability, use, and barriers to the use of CR.
Electronic databases (Cochrane Library, EMBASE, PubMed, Web of Science) were searched from January 1, 1980 to May 31, 2013 for articles on CR in LMIC. Citations on availability, use, and/or barriers to CR were screened for inclusion by title, abstract, and full text. Data were summarized by region or country to determine the characteristics of CR in LMIC and gaps in the peer-reviewed biomedical publications.
Our search yielded a total of 5,805 citations, of which 34 satisfied full inclusion and exclusion criteria. The total number of CR programs available ranged from 1 in Algeria and Paraguay to 51 in Serbia. Referral rates for CR ranged from 5.0% in Mexico to 90.3% in Lithuania. Attendance rates ranged from 31.7% in Bulgaria to 95.6% in Lithuania, and CR attendance was correlated with higher educational background. The most commonly cited barrier to CR in LMIC was lack of physician referral.
Our results illustrate that the published reports reflects heterogeneity of CR availability and use in LMIC. Overall, CR is insufficiently available and underutilized. Further characterization of CR in LMIC, especially in Asia and Africa, is necessary to develop targeted strategies to improve availability and utilization. Patient, physician, and systems factors must be addressed to overcome barriers to participation in CR in LMIC.
心脏康复（CR）是缺血性心脏病二级预防的基石。在中低收入国家（LMIC），缺血性心脏病负担沉重且不断增加，CR 至关重要。然而，LMIC 中 CR 的可及性和使用率尚不清楚。
本研究旨在描述 LMIC 中 CR 的可及性、使用情况和使用障碍。
从 1980 年 1 月 1 日至 2013 年 5 月 31 日，通过 Cochrane 图书馆、EMBASE、PubMed 和 Web of Science 电子数据库搜索关于 LMIC 中 CR 的文章。根据标题、摘要和全文筛选出关于 CR 的可用性、使用情况和/或使用障碍的参考文献，以确定 LMIC 中 CR 的特征和同行评议生物医学文献中的空白。
我们的搜索共产生了 5805 条引文，其中 34 条符合全部纳入和排除标准。可用的 CR 项目总数从阿尔及利亚和巴拉圭的 1 个到塞尔维亚的 51 个不等。CR 的转诊率从墨西哥的 5.0%到立陶宛的 90.3%不等。参与率从保加利亚的 31.7%到立陶宛的 95.6%不等，CR 的参与与较高的教育背景有关。LMIC 中 CR 最常被引用的障碍是缺乏医生转诊。
我们的研究结果表明，发表的报告反映了 LMIC 中 CR 的可及性和使用情况存在异质性。总体而言，CR 的可及性和使用率不足。需要进一步描述 LMIC 中的 CR，特别是在亚洲和非洲，以制定有针对性的策略来提高 CR 的可及性和使用率。必须解决患者、医生和系统因素，以克服 LMIC 中参与 CR 的障碍。
