Lima de Melo Ghisi Gabriela, Pesah Ella, Turk-Adawi Karam, Supervia Marta, Lopez Jimenez Francisco, Grace Sherry L
Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M5G2A2, Canada.
School of Kinesiology and Health Science, York University, Toronto, ON M3J1P3, Canada.
J Clin Med. 2018 Sep 7;7(9):260. doi: 10.3390/jcm7090260.
Alternative models of cardiac rehabilitation (CR) delivery, such as home or community-based programs, have been developed to overcome underutilization. However, their availability and characteristics have never been assessed globally. In this cross-sectional study, a piloted survey was administered online to CR programs globally. CR was available in 111/203 (54.7%) countries globally; data were collected in 93 (83.8% country response rate). 1082 surveys (32.1% program response rate) were initiated. Globally, 85 (76.6%) countries with CR offered supervised programs, and 51 (45.9%; or 25.1% of all countries) offered some alternative model. Thirty-eight (34.2%) countries with CR offered home-based programs, with 106 (63.9%) programs offering some form of electronic CR (eCR). Twenty-five (22.5%) countries with CR offered community-based programs. Where available, programs served a mean of 21.4% ± 22.8% of their patients in home-based programs. The median dose for home-based CR was 3 sessions (Q25-Q75 = 1.0⁻4.0) and for community-based programs was 20 (Q25⁻Q75 = 9.6⁻36.0). Seventy-eight (47.0%) respondents did not perceive they had sufficient capacity to meet demand in their home-based program, for reasons including funding and insufficient staff. Where alternative CR models are offered, capacity is insufficient half the time. Home-based CR dose is insufficient to achieve health benefits. Allocation to program model should be evidence-based.
为了克服利用率不足的问题,已经开发了替代的心脏康复(CR)提供模式,如居家或社区项目。然而,它们的可用性和特点从未在全球范围内得到评估。在这项横断面研究中,对全球的CR项目进行了一项在线试点调查。全球111/203个(54.7%)国家提供CR;在93个国家收集了数据(国家回复率为83.8%)。启动了1082项调查(项目回复率为32.1%)。在全球范围内,提供CR的85个(76.6%)国家提供有监督的项目,51个(45.9%;或占所有国家的25.1%)提供某种替代模式。提供CR的38个(34.2%)国家提供居家项目,其中106个(63.9%)项目提供某种形式的电子CR(eCR)。提供CR的25个(22.5%)国家提供社区项目。在有居家项目的地方,项目服务的患者平均占其患者总数的21.4%±22.8%。居家CR的中位疗程数为3次(四分位数间距Q25-Q75 = 1.0-4.0),社区项目为20次(Q25-Q75 = 9.6-36.0)。78名(47.0%)受访者认为他们没有足够的能力满足居家项目的需求,原因包括资金和人员不足。在提供替代CR模式的地方,有一半的时间能力不足。居家CR剂量不足以实现健康效益。项目模式的分配应以证据为基础。