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AuthorBritto, Raquel Rodrigues
AuthorSupervia, Marta
AuthorTurk-Adawi, Karam
AuthorChaves, Gabriela Suéllen da Silva
AuthorPesah, Ella
AuthorLopez-Jimenez, Francisco
AuthorPereira, Danielle Aparecida Gomes
AuthorHerdy, Artur H
AuthorGrace, Sherry L
Available date2019-05-13T06:52:04Z
Publication Date2019-03-01
Publication NameBrazilian Journal of Physical Therapyen_US
CitationBritto RR, Supervia M, Turk-Adawi K, Chaves GSDS, Pesah E, Lopez-Jimenez F, Pereira DAG, Herdy AH, Grace SL. Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries. Braz J Phys Ther. 2019 Mar 5. pii: S1413-3555(18)30945-6. doi: 10.1016/j.bjpt.2019.02.011
AbstractBrazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. This study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). In this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N=249 programmes). Cardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n=16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8±1.9 staff (versus 5.9±2.8 in other upper-MICs, p<0.05), offering 4.0±1.6/10 core components (versus 6.0±1.5 in other upper-MICs, p<0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25-75=29-65) vs. 32 sessions/patient (Q25-75=15-40) in other upper-MICs (p<0.01). Brazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.
SponsorThis project was supported by a research grant from York University's Faculty of Health, Canada; Conselho Nacional de Pesquisa (CNPq# 305786/2014-8), Brazil; Coordenação de Aperfeiçoamento de Pessoal de N&iuml;vel Superior(CAPES - Código de Financiamento 001), Brazil and Fundação de Pesquisa de Minas Gerais (FAPEMIG # PPM00869-15 and 00554-17), Brazil
SubjectHealth services
SubjectUpper-middle income country
TitleCardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries.

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