3 research outputs found
Consenso de la Sociedad Mexicana de Cardiología para el seguimiento clínico cardiovascular post-COVID-19
Antecedentes: Las secuelas cardiovasculares ocasionadas por la enfermedad por coronavirus 2019 (COVID-19) son frecuentes en una importante proporción de los pacientes recuperados del cuadro agudo de la enfermedad. Hasta el día de hoy el seguimiento cardiológico del síndrome agudo post-COVID-19 (SPC-19A) se ha realizado de forma heterogénea y sin directrices que permitan al clínico identificar oportunamente los cambios que preceden a enfermedades cardiológicas derivadas de los distintos mecanismos de daño inducidos por COVID-19. Objetivos: Estandarizar la atención y seguimiento cardiovascular de los supervivientes de COVID-19 en función de la gravedad de la enfermedad e identificar a los pacientes que desarrollen SPC-19A para su atención oportuna. Material y métodos: Mediante una revisión extensa de bibliografía, este documento tiene la intención de unificar y proporcionar la información necesaria para diagnosticar y dar seguimiento a las complicaciones cardiacas que se han documentado en los meses posteriores a la resolución de la COVID-19 aguda
Nature of cardiac rehabilitation around the globe
Abstract
Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.
Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.
Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05).
Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes
Cardiac rehabilitation availability and density around the globe
Abstract
Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.
Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.
Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < 0.001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = 0.92, 95%CI = 0.91–0.93) or public (OR = 0.83, 95%CI = 0.82–0.84) funding compared to hybrid sources.
Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25–Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.
Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation