Qatar University, Al Jamiaa St, Doha, Qatar.
Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain; Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Int J Cardiol. 2019 Jun 15;285:147-153. doi: 10.1016/j.ijcard.2019.02.065. Epub 2019 Mar 14.
This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries.
In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates.
Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n = 8; versus globally p < .001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n = 378, 36.3% globally; p < .001). Over 80% of programs accepted guideline-indicated patients. Nurses (n = 20, 95.2%), cardiologists (n = 18, 85.7%) and dietitians (n = 18, 85.7%) were the most common healthcare providers on CR teams (mean = 6.4 ± 2.2/program; 5.9 ± 2.8 globally, p = .18). On average, programs offered 8.9 ± 1.7/11 core components (versus 8.7 ± 1.9 globally, p = .90). These were most commonly initial assessment, management of risk factors, and patient education (n = 21, 100.0% for each), and least commonly return-to-work counselling (n = 15 71.4%). Mean dose was 27.0 ± 13.5 sessions (versus 28.7 ± 27.6 globally, p = .38). Seven (33.3%) programs offered some alternative models.
CR is insufficiently implemented, with 2,079,283 more spots needed/year across the EMR. But where offered, CR is consistent with guidelines.
本研究旨在：（1）确认心脏康复（CR）的可用性；（2）确定 CR 的密度和未满足的需求；（3）确定东地中海地区（EMR）的项目性质；（4）比较这些（a）按 EMR 国家和（b）与其他国家的情况。
在这项横断面研究中，对全球的 CR 项目进行了调查。心脏协会和当地的拥护者促进了项目的确定。CR 的需求是基于全球疾病负担研究缺血性心脏病（IHD）的估计。
在 22 个 EMR 国家中，有 12 个（54.5%）确定了 CR 项目。9 个（75.0%的国家响应率）国家参与了调查，启动了 24/49（49.0%的项目响应率）项调查。每 104 例新发 IHD 患者/年有 1 个 CR 点（全球为 12 个）。三分之一的反应项目是私人资助的（n=8；与全球相比，p<.001），在 18 个（75.0%）项目中，患者自费支付部分或全部费用（与全球 n=378，36.3%；p<.001）。超过 80%的项目接受了指南推荐的患者。护士（n=20，95.2%）、心脏病专家（n=18，85.7%）和营养师（n=18，85.7%）是 CR 团队中最常见的医疗保健提供者（平均每个项目 6.4±2.2/人；全球为 5.9±2.8，p=.18）。平均而言，项目提供了 8.9±1.7/11 个核心组成部分（全球为 8.7±1.9，p=.90）。这些项目最常见的是初始评估、危险因素管理和患者教育（n=21，每项 100.0%），而最不常见的是重返工作岗位咨询（n=15，71.4%）。平均剂量为 27.0±13.5 次（全球为 28.7±27.6，p=.38）。有 7 个（33.3%）项目提供了一些替代模式。
CR 的实施不足，整个 EMR 地区每年需要增加 2079283 个 CR 点。但是，在提供的情况下，CR 符合指南。
