Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR

1

Simplified Strategies of CR in Low-Resource Settings:

Perspectives from ICCPRSherry L. Grace, PhD

Secretary/Treasurer, ICCPRFull Professor, York University

Director of Research, Cardiac RehabUniversity Health Network

2

Disclosure Statement of Financial Interest

I, Sherry Grace DO NOT have a financial interest/arrangement or affiliation with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

3WHO Global Atlas CVD Prev & Control,2011

4

Availability of CR Globally

Adawi et al., (accepted in principle) Nature Reviews:

Cardiology

Global Availability of CR by Country Income Classification

High-income countries: 68.0% (51/75 countries)

Middle-income countries: 28.2% (29/103 countries)Low-income countries: 8.3% (3/36 countries)

Globally: 38.8% (83/214 countries)

LMICs: 23.0%

5Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (accepted in principle). Nature Reviews: Cardiology.

6

21 Associations of the

7 1993

8

• “define health system-related opportunities … to access for … rehabilitation … and develop feasible and integrated approaches to apply cost-effective NCD interventions at all levels of health care”

2011; p. 46

9

CR delivery model for low-resource settings: A consensus statement

• Primary Writing Panel• Grace, S.L., Turk-Adawi, K., Contractor, A., Atrey, A.,

Campbell, N., Derman, W., Ghisi, G.M.G., Hu, D., Lopez, F., Mendis, S.,(WHO) & Sarrafzadegan, N.

• Secondary Writing Panel• Buckley, J., Akinroye, K. (WHF), Mola, A., Neubeck,

L., Pogosova, N., & Rivas-Estany, E.

10

Literature Review: Search Strategy

1. Comprehensive search using Medline and Embasea- cardiac diseasesb- rehabilitationc- LMICs

2. Grey literature search for reports, guidelines

11Buckley et al ., Heart, 2013

12

Literature Search ResultsComponent # citationsCR in LMICs 1417CR models 130Psychological therapy 566Obesity 295Lipids 152Blood pressure 215Education interventions 318Smoking cessation 237Nutrition interventions 274

Alternative Models of CR Delivery

Low-cost, accessible models:Home-based (Dalal etal., 2010) Community-based (Mandic et al., 2013)

Use of technology (evidence lacking, weak)Internet-based (Munro et al., 2013)

telehealth, and mobile (Beatty et al., 2013)

15

Developing national policies support CR provision Randomized controlled trials of CR in LMICs

Provide cost-effectiveness data CR part of integrated cardiology service

Expanding health human resources & service delivery Integration of CR in the curricula of medical schools

Training of healthcare professionals (“Task-shifting”)

Increasing the hours of operation of existing programs

Implementation Considerations

16

Next Steps

• Literature review• Writing• 2ndary Panel review, revision• Submission to Nature Reviews:

Cardiology• WCC 2016 – launch?• Field and feasibility testing in low-resource

settings

17

Acknowledgments• Lit search: Maureen Pakosh, MIst

• Nizal Sarrafzadegan, MD (co-chair)

• Contact: [email protected]

• Funding:

Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR

Documents

Transcript of Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR