Cardiac rehabilitation delivery model for low-resource settings

Heart. 2016 Sep 15;102(18):1449-55. doi: 10.1136/heartjnl-2015-309209. Epub 2016 May 15.


Objective: Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.

Methods: A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.

Results: Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.

Conclusions: Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Activities of Daily Living
  • Cardiac Rehabilitation / economics*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / economics*
  • Cardiovascular Diseases / therapy*
  • Consensus
  • Cost-Benefit Analysis
  • Delivery of Health Care / economics*
  • Delivery of Health Care / organization & administration
  • Exercise Therapy / economics
  • Health Care Costs*
  • Health Resources / economics*
  • Health Resources / organization & administration
  • Humans
  • Models, Organizational
  • Patient Education as Topic / economics
  • Return to Work / economics
  • Risk Reduction Behavior
  • Self Care / economics