Cardiac Rehabilitation in the Eastern Mediterranean Region: Utilization and Barriers Supervisor ofThesis: Karam Turk-Adawi, Mohammed Fasihul Alam

Abstract

Background: Cardiovascular diseases (CVDs) are the leading cause of death and disability in the Eastern Mediterranean Region (EMR). In the next decade, CVDs are estimated to increase in the EMR more dramatically than any other World Health Organization-designated region, except Africa. Cardiac rehabilitation (CR) is a comprehensive secondary prevention program that designed to recover a cardiovascular event. Purpose: The purpose of this study is to investigate characteristics, availability, utilization, and barriers to CR programs in the EMR. Methods: This is an observational, cross-sectional study, based on a secondary dataset driven from a global study conducted by the International Council of Cardiovascular Disease Prevention and Rehabilitation. Statistical analysis methods: Descriptive statistics: frequencies, percentages, means, standard deviations, and medians were used to describe findings. Results: Of the 22 countries in EMR, only 12 (54.5%) countries offered CR; 49 programs were identified but only 24 participated (response rate=49.0%). All identified CR programs were located in urban areas. CR density in EMR, ranged from 184,744 patients with ischemic heart disease per program in Egypt to 3,842 patients per program in Bahrain. Only 8 (38.1%) respondents reported that patients were referred regularly to their CR program. The duration of CR programs varied from 5 weeks in Tunisia to 20 weeks in Lebanon with an average of 9.4±5.4 weeks in EMR. Only 5 (20.8 %) programs were publicly funded while 8 (33.3%) were privately funded. CR programs were underutilized with a range of ratio of capacity served to actually serve per year of 1.2:1 to 8.0:1 in Qatar and Egypt, respectively. Lack of patient referral, lack of financial and human resources were perceived as the most barriers to CR. Conclusion: In EMR, CR programs were insufficiently implemented for a population with a high and growing burden of cardiovascular diseases. CR was underutilized and this should trigger policy makers to conduct further studies to explore the factors that affect utilization of these programs in these countries. Additionally, development of national and regional regulations and laws regarding CR is a necessity to drive improvement of services and bringing evidence-based guidelines.