Posted on July 03, 2019

Qatar University (QU) participated in a global study showing gross cardiac rehabilitation insufficiency worldwide. Just one in 12 heart attack victims globally receive rehabilitation to prevent another event, according to the first ever audit of cardiac rehabilitation around the world, undertaken by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR). Over 18 million more spots are needed every year.

Senior author Prof. Sherry Grace of York University and University Health Network, Canada says, “Almost half of countries around the world have absolutely no rehab programs and people will be dying unnecessarily without them.”

Two papers reporting on the global audit were published today in the journal EClinicalMedicine of the prestigious Lancet journal family quantifying how much rehab capacity exists in relation to the need in every country of the world, and the quality of programs in countries where it does exist. The region of Africa is greatly in need of more programs and India, China and Russia each need millions more rehabilitation spots to treat the average number of patients that develop heart disease each year currently. Unfortunately, that number is expected to grow.

The two papers are a culmination of three years of effort amongst a global collaborative team of 60 investigators and other collaborators. The research was led by Professor Sherry Grace of York University/Canada, and three primary investigators: Dr. Karam Turk Adawi from Qatar University, Qatar; Dr. Francisco Lopez-Jimenez from Mayo Clinic, USA; and Dr. Marta Supervia from Gregorio Marañón General University Hospital, Spain. The papers report on the first-ever audit of cardiac rehab programs globally, undertaken in response to calls by international organizations including the World Health Organization, for implementation of preventive strategies to reduce the burden of cardiovascular disease, the leading killer worldwide. The protocol of this global survey was endorsed by several international organizations, including the World Heart Federation.

“This is a call for governments and policy-makers to support cardiac rehab programs,” said lead author Asst. Prof. Turk-Adawi from QU. “Every patient with heart disease has the right to have a place in a cardiac rehab program. It is sad to see patients dying at young ages from this preventable disease, especially in developing countries, while they can benefit from the program.” Turk-Adawi reports the situation is the same in the Middle East, where only half of countries offer rehab programs, and 2,079,283 more rehab spots are needed every year to treat new cases of heart disease. “In Qatar, despite having a well-established program with good quality and a plan for its expansion, there is only one spot for every 37 heart patients that need it. We need capacity to treat 6,811 more patients every year,” he says.

Professor Asmaa Al Thani, Dean of College of Health Sciences, Qatar University, expressed the University's support for such research, which serves the global health. “This is an important global study that underlines a gap in health services worldwide. Qatar University supports national and international efforts to mitigate the adverse effects of major health issues like heart disease.” The almost 6,000 programs that did exist generally met the minimum recommended standards, offering an average of 9 out of the 11 core components, but this varied by region. There was patchy delivery of interventions to stop smoking, manage stress and support return-to-work.

“Tobacco cessation is one of the most effective ways to reduce the risk of heart attacks and prolong survival, so all cardiac rehabilitation programs should offer this service,” said Dr. Supervia, lead author of the sister paper, from Gregorio Marañón General University Hospital in Spain. “Likewise, programs require more consistent provision of return-to-work support, such as negotiating modified work or part-time employment to help patients maintain a rewarding life and financial stability, while reducing the negative impact of cardiovascular disease on the economy.”

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