Global Cardiac Rehabilitation

WCC ICCPR Council MeetingCardiovascular disease is global epidemic, but is at its worst in the developing world. Cardiac rehabilitation (CR) is an established model of care with structured exercise at its core, proven to reduce mortality by 25% and morbidity by 20% in patients with this disease. Unfortunately, research demonstrates low use of, and inequality in access, to CR, particularly in the places where it is needed most. A recent invited review by Prof. Grace and colleagues shows that only 2/3rds of high-income countries have CR, and only ΒΌ of developing countries do. There are a combination of factors relating to patients, physicians, and the health care system itself that lead to low CR use.

Along with some colleagues, Prof. Grace founded the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR; to tackle these issues. ICCPR leaders engaged 29 national / regional CR / secondary prevention associations from around the world, who have formally named Board members to the ICCPR Council. ICCPR is an official member of the World Heart Federation. Together, these associations developed and endorsed a Charter, stating their goal of harmonizing efforts to promote CR delivery.

ICCPR Map of AssociationsThey have since gone on to summarize the evidence on the benefits of CR in low and middle-income countries, surveyed member countries regarding reimbursement models for CR and program characteristics, and developed an advocacy toolkit to promote greater delivery of CR. Given the last international-scale guidance on CR delivery in low-resource settings was published almost 25 years ago by the World Health Organization, ICCPR most-recently endeavored to systematically develop practical, evidence-based recommendations on how to deliver each of the core components of CR in low-resource settings. While it is cost-effective to deliver these programs in countries such as Canada, the United Kingdom and United States, the situation in developing countries is different.

Selected Outputs from the Project:

  1. Grace, S.L., Warburton, D.E.R., Stone, J.A., Sanderson, B., Oldridge, N., Jones, J., Wong, N., & Buckley, J.P. (2013). International charter on cardiovascular prevention and rehabilitation: A call for action. JCRP, 33(2):128-31. March/April.
  2. Shanmugasegaram, S.*, Terzic, C., Xiang, J. & Grace, S.L. (2014). Cardiac rehabilitation services in low and middle-income countries: A scoping review. Journal of Cardiovascular Nursing, 29(5): 454-463. Sept/Oct.
  3. Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (2014). Global availability of cardiac rehabilitation. Nature Reviews: Cardiology, 11(10): 586-596. October.
  4. Turk-Adawi, K., & Grace, S.L. (2015). Narrative review comparing the benefits of, participation cardiac rehabilitation in high-, middle- and low-income countries. Heart, Lung and Circulation, 24(5): 510-520. May. doi: 10.1016/j.hlc.2014.11.013
  5. Grace, S.L., Turk-Adawi, K., Contractor, A., Atrey, A., Campbell, N., Derman, W., Ghisi, G.M.G.*, Hu, D., Mendis, S., Oh, P., Oldridge, N., Sarkar, B., & Yeo, T.J., Lopez, F., & Sarrafzadegan, N. (2016). Consensus statement: Cardiac rehabilitation delivery model for low-resource settings. Heart;102:1449-1455. September. DOI:10.1136/heartjnl-2015-309209
  6. Grace, S.L., Turk-Adawi, K.I., Contractor, A., Atrey, A., Campbell, N.R., Derman, W., Ghisi, G.L.*, Sarkar, B.K, Yeo, T.J., Lopez-Jimenez, F., Buckley, J., Hu, D., & Sarrafzadegan, N. (2016). Cardiac rehabilitation delivery model for low-resource settings: An International Council of Cardiovascular Prevention and Rehabilitation consensus statement. Progress in CVD;59(3):303-322. Nov/Dec. doi: 10.1016/j.pcad.2016.08.004.
  7. Babu, A., Lopez-Jimenez, F., Thomas, R.J., Isaranuwatchai, W., Herdy, A.H., Hoch, J., & Grace, S.L. (2016). Advocacy for outpatient cardiac rehabilitation globally. BMC Health Services Research;16:471. September. DOI: 10.1186/s12913-016-1658-1