Heart (British Cardiac Society) · 2016
Cardiac rehabilitation delivery model for low-resource settings.
СтатьяКлинические рекомендацииОбзорНазвание и аннотация: Перевод в очереди
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Grace Sherry L, Turk-Adawi Karam I, Contractor Aashish, Atrey Alison, Campbell Norm, Derman Wayne, Melo Ghisi Gabriela L, Oldridge Neil, Sarkar Bidyut K, Yeo Tee Joo, Lopez-Jimenez Francisco, Mendis Shanthi, Oh Paul, Hu Dayi, Sarrafzadegan Nizal
Аннотация
OBJECTIVE: Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.
METHODS: A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.
RESULTS: Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.
CONCLUSIONS: Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.
METHODS: A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.
RESULTS: Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.
CONCLUSIONS: Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.