Browsing by Author "Simon, A"
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- Cardiac Rehabilitation Availability and Density Around the GlobePublication . Turk-Adawi, K; Supervia, M; Lopez-Jimenez, F; Pesah, E; Ding, R; Britto, RR; Bjarnason-Wehrens, B; Derman, W; Abreu, A; Babu, AS; Santos, CA; Jong, SK; Cuenza, L; Yeo, TJ; Scantlebury, D; Andersen, K; Gonzalez, G; Giga, V; Vulic, Du; Vataman, E; Cliff, J; Kouidi, E; Yagci, I; Kim, C; Benaim, B; Estany, ER; Fernandez, R; Radi, B; Gaita, D; Simon, A; Chen, SY; Roxburgh, B; Martin, JC; Maskhulia, L; Burdiat, G; Salmon, R; Lomelí, H; Sadeghi, M; Sovova, E; Hautala, A; Tamuleviciute-Prasciene, E; Ambrosetti, M; Neubeck, L; Asher, E; Kemps, H; Eysymontt, Z; Farsky, S; Hayward, J; Prescott, E; Dawkes, S; Santibanez, C; Zeballos, C; Pavy, B; Kiessling, A; Sarrafzadegan, N; Baer, C; Thomas, R; Hu, D; Grace, SLBackground: 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 < .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 = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) 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.
- Exercise-Based Cardiac Rehabilitation in Twelve European Countries Results of the European Cardiac Rehabilitation RegistryPublication . Benzer, W; Rauch, B; Schmid, JP; Zwisler, A; Dendale, P; Davos, C; Koudi, E; Simon, A; Abreu, A; Pogosova, N; Gaita, D; Miletic, B; Bönner, G; Ouarrak, T; McGee, HAIM: Results from EuroCaReD study should serve as a benchmark to improve guideline adherence and treatment quality of cardiac rehabilitation (CR) in Europe. METHODS AND RESULTS: Data from 2.054 CR patients in 12 European countries were derived from 69 centres. 76% were male. Indication for CR differed between countries being predominantly ACS in Switzerland (79%), Portugal (62%) and Germany (61%), elective PCI in Greece (37%), Austria (36%) and Spain (32%), and CABG in Croatia and Russia (36%). A minority of patients presented with chronic heart failure (4%). At CR start, most patients already were under medication according to current guidelines for the treatment of CV risk factors. A wide range of CR programme designs was found (duration 3 to 24weeks; total number of sessions 30 to 196). Patient programme adherence after admission was high (85%). With reservations that eCRF follow-up data exchange remained incomplete, patient CV risk profiles experienced only small improvements. CR success as defined by an increase of exercise capacity >25W was significantly higher in young patients and those who were employed. Results differed by countries. After CR only 9% of patients were admitted to a structured post-CR programme. CONCLUSIONS: Clinical characteristics of CR patients, indications and programmes in Europe are different. Guideline adherence is poor. Thus, patient selection and CR programme designs should become more evidence-based. Routine eCRF documentation of CR results throughout European countries was not sufficient in its first application because of incomplete data exchange. Therefore better adherence of CR centres to minimal routine clinical standards is requested.