Taylor Rod S, Chaudhry Imran Bashir, Faraque Mithila, Jeemon Panniyammakal, Blakemore Amy, Lovell Karina, Husain Nusrat, Saghir Tahir, Mashreky Saidur Rahman, Harikrishnan Sivadasanpillai, Ahmed Chaudhury Meshkat, Samuel Babu Abraham, McConnachie Alex, McIntosh Emma, Memon Rakhshi, Singh Sally, Leyland Alastair, Jani Bhautesh, Flores Walter
School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Scotland, G12 8TA, UK.
Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan.
NIHR Open Res. 2025 May 6;5:41. doi: 10.3310/nihropenres.13957.1. eCollection 2025.
The evidence and infrastructure needed to access and deliver cardiac rehabilitation (CR) services are absent or lacking in low and middle-income countries (LMICs), resulting in a substantial loss of potential health and socio-economic benefits. Home-based programmes provide an affordable model of delivery that can leverage a scalable increase in CR access in LMICs. ACROSS (Affordable Cardiac Rehabilitation: An Outreach Inter-disciplinary Strategic Study) seeks to co-develop (with patients, caregivers, clinicians, and service commissioners) a culturally and contextually applicable and affordable home-based programme for people with the multimorbidity of coronary heart disease and/or heart failure with co-existing depression and/or anxiety and evaluate the acceptability, clinical effectiveness, and cost-effectiveness of its implementation in Bangladesh, India, and Pakistan and to determine its scalability and sustainability.
Four linked work packages (WPs). WP1 (cultural adaptation/refinement of home-based rehabilitation): examine rehabilitation implementation barriers/enablers from multiple stakeholder perspectives and co-develop a feasible and acceptable culturally & contextually adapted home-based programme, extended to take account of co-existing depression and/or anxiety; WP2 (external pilot): assess feasibility/acceptability of the co-developed rehabilitation intervention and study design and processes necessary for a full-scale trial; WP3: (multicentre/multi-country hybrid effectiveness and implementation randomised trial) determine the clinical and cost-effectiveness of a culturally adapted home-based rehabilitation intervention for people with coronary heart disease and/or heart failure and depression and/or anxiety; WP4 (capacity building): build research and rehabilitation delivery capacity.
The ACROSS programme overarching goal is to develop a clinically and cost-effective CR model in low-resource settings for people in Bangladesh, India, and Pakistan with a multimorbidity of heart disease and depression and/or anxiety with the potential for substantial health and socio-economic benefits.
低收入和中等收入国家（LMICs）缺乏获取和提供心脏康复（CR）服务所需的证据和基础设施，导致潜在的健康和社会经济效益大量流失。居家项目提供了一种经济实惠的服务模式，可以在低收入和中等收入国家扩大心脏康复服务的可及性。ACROSS（经济实惠的心脏康复：一项外展跨学科战略研究）旨在（与患者、护理人员、临床医生和服务专员共同）为患有冠心病和/或心力衰竭合并抑郁症和/或焦虑症的多病共存患者共同开发一种文化上和背景上适用且经济实惠的居家项目，并评估其在孟加拉国、印度和巴基斯坦实施的可接受性、临床有效性和成本效益，以及确定其可扩展性和可持续性。
四个相互关联的工作包（WPs）。工作包1（居家康复的文化适应/优化）：从多个利益相关者的角度检查康复实施的障碍/促进因素，并共同开发一个可行且可接受的、文化和背景适应的居家项目，扩展到考虑共存的抑郁症和/或焦虑症；工作包2（外部试点）：评估共同开发的康复干预措施以及全面试验所需的研究设计和流程的可行性/可接受性；工作包3（多中心/多国混合有效性和实施随机试验）：确定针对患有冠心病和/或心力衰竭以及抑郁症和/或焦虑症的患者的文化适应居家康复干预措施的临床和成本效益；工作包4（能力建设）：建设研究和康复服务能力。
ACROSS项目的总体目标是在资源匮乏的环境中为孟加拉国、印度和巴基斯坦患有心脏病和抑郁症和/或焦虑症的多病共存患者开发一种临床和成本效益高的心脏康复模式，具有显著的健康和社会经济效益潜力。
