Background

Brazil 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.

Objective

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).

Methods

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).

Results

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).

Conclusion

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.

中文翻译：

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巴西心脏康复的可用性和实施​​情况：与其他中高收入国家的比较。

背景

巴西的心脏康复能力不足，但未满足需求的密度和地区差异尚不清楚。而且南美有CR指南，但交付是否符合没有说明。

客观的

本研究旨在确定：(1) 心脏康复数量和密度，(2) 计划的性质，以及 (3) 通过以下方面进行比较：(a) 巴西地区和 (b) 与其他中高收入国家（中上收入国家） -MIC）。

方法

在这项横断面研究中，对全球心脏康复项目进行了一项调查。心脏协会参与促进项目识别。使用全球疾病负担研究缺血性心脏病发病率估计值计算密度。结果与来自 29 个具有心脏康复的高 MIC 的数据（ N = 249 个项目）进行了比较 。

结果

巴西所有地区均提供心脏康复服务，其中 30/75 的项目启动了调查（项目响应率为 40.0%）。每99名缺血性心脏病患者就只有1个心脏康复点。大多数项目由政府/医院资助（n  = 16，53.3%），但在 11 个项目中（36.7%）患者依赖私人健康保险。≥70% 的项目接受了指南规定的条件。该项目拥有一支由 3.8 ± 1.9 名员工组成的团队（相对于其他中等收入国家中的 5.9 ± 2.8 人，p  < 0.05），提供 4.0 ± 1.6/10 个核心组件（相对于其他中等收入国家中的 6.0 ± 1.5 人，p  < 0.01；更多烟草特别需要戒烟和重返工作咨询）在其他高 MIC 中，每患者超过 44.5 次疗程 (Q25–75 = 29–65)，而每患者 32 次疗程 (Q25–75 = 15–40) ( p  < 0.01) ）。

结论

巴西的心脏康复能力必须得到增强，但在可用的情况下，各地区的服务是一致的，但在人员规模和提供的核心组成部分方面与其他中高端国家有所不同。