More than 20 million people develop heart disease globally each year, but there is only one cardiac rehab spot for every 12 of those patients to prevent another heart event, according to new research from York University. A global audit and survey of cardiac rehab conducted in York University’s Faculty of Health showed that cardiac rehab is available in only half of the world’s countries, and the programs that do exist can only serve 1.65 million patients, leaving a gap of over 18 million patients in need.

This first-ever audit and survey was undertaken through the International Council of Cardiovascular Prevention and Rehabilitation. Heart disease is a chronic condition;  cardiac rehabilitation provides heart attack patients structured exercise, risk factor management, as well as education and counselling to optimize their quality of life. Previous research has shown cardiac rehab reduces cardiovascular death and re-hospitalization by 20 per cent.

Two papers reporting on the global audit and survey were published in the journal EClinicalMedicine of the Lancet family today, quantifying how much rehab capacity exists in relation to need in every country, and the quality of programs in countries where it exists. Sherry Grace, professor in the Faculty of Health at York University was the senior investigator on the studies, with lead authors Turk-Adawi of Qatar University and Marta Supervia of Gregorio Marañón General University Hospital.

“Almost half of countries around the globe have absolutely no cardiac rehab,” said Grace. “People are dying unnecessarily without these programs.”

The goal of the first study was to establish availability of cardiac rehab and capacity to serve patients globally. The global team of 58 investigators established that cardiac rehab programs were available in 55 percent of the approximately 200 countries in the world. Researchers then surveyed all of the almost 6,000 programs and got responses from 93 of the 111 countries with rehab. Programs reported treating fewer than expected patients every year, due primarily to lack of resources.

Previously-published data from this study shows that while Canada ranks among the best in the world for program capacity, cardiac rehab is only available in the provinces, with no programs in the Territories. Overall, there is only one cardiac rehab spot for every 4.5 heart attack patients each year nationally. While Ontario has the most programs, the unmet need for cardiac rehab is greatest there.

Africa and South-East Asia are the regions in the greatest need of more programs. India, China and Russia were the countries in greatest need; each needs millions more rehab spots to treat the average number of patients that develop heart disease each year currently, and unfortunately that number is expected to grow.

The second study presented the results of the first-ever survey of the cardiac rehab programs worldwide that exist, to find out the nature of services delivered, such as types of patients served, number and types of healthcare professionals on the rehab teams, and services delivered. This study found cardiac rehab programs are of high quality where they are available, and often treat patients with chronic conditions other than heart disease.

The results showed that the existing programs generally met international standards, offering an average of nine out of the 11 recommended core components, but this varied by region. There was inconsistent delivery of interventions for tobacco cessation, managing stress and supporting return-to-work; the situation is the same in Canada. Programs were staffed by an average of 6 staff to deliver these components, generally comprising exercise professionals, nurses, dietitians and physicians.

Researchers say advocacy is needed for more programs that are reimbursed by public healthcare systems or private healthcare insurance. “Increased capacity could be also be achieved by delivering more unsupervised programs – for example by exploiting technology through home-based cardiac rehabilitation, which was offered in only 38 countries. Delivery in these settings is just as effective at reducing death in heart patients,” says Grace.

The protocol of this global study was endorsed by several international organizations, including the World Heart Federation.