{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:48:53Z","timestamp":1793213333874,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"23","funder":[{"name":"York University Faculty of Health"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2019,5,26]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low\/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CR was identified in 55\/138 (39.9%) LMICs; 47\/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; p&lt;0.001). Over 85% of programmes accepted guideline-indicated patients. Cardiologists (n=266, 89.3%), nurses (n=234, 79.6%; vs 544, 91.7% in HICs, p=0.001) and physiotherapists (n=233, 78.7%) were the most common providers on CR teams (mean=5.8\u00b12.8\/programme). Programmes offered 7.3\u00b11.8\/10 core components (vs 7.9\u00b11.7 in HICs, p&lt;0.01) over 33.7\u00b130.7 sessions (significantly greater in publicly funded programmes; p&lt;0.001). Publicly funded programmes were more likely to have social workers and psychologists on staff, and to offer tobacco cessation and psychosocial counselling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-314486","type":"journal-article","created":{"date-parts":[[2019,6,28]],"date-time":"2019-06-28T17:15:51Z","timestamp":1561742151000},"page":"1806-1812","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":98,"title":["Cardiac rehabilitation delivery in low\/middle-income countries"],"prefix":"10.1136","volume":"105","author":[{"given":"Ella","family":"Pesah","sequence":"first","affiliation":[{"name":"School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karam","family":"Turk-Adawi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Qatar University, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Supervia","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Gregorio Mara\u00f1\u00f3n General University Hospital, Madrid, Spain"},{"name":"Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Lopez-Jimenez","sequence":"additional","affiliation":[{"name":"Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9533-3654","authenticated-orcid":false,"given":"Raquel","family":"Britto","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjing","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peiking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Manipal University, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizal","family":"Sarrafzadegan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran"},{"name":"School of Population and Public Health, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucky","family":"Cuenza","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology, Philippine Heart Center, Quezon City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Anchique Santos","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Cardiac Rehabilitation, Mediagn\u00f3stica Duitama, Boyac\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Heine","sequence":"additional","affiliation":[{"name":"Institute of Sports and Exercise Medicine and Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Derman","sequence":"additional","affiliation":[{"name":"Institute of Sports and Exercise Medicine and Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Oh","sequence":"additional","affiliation":[{"name":"Cardiovascular Rehabilitation, University Health Network \u2013 Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L","family":"Grace","sequence":"additional","affiliation":[{"name":"Cardiovascular Rehabilitation, University Health Network \u2013 Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,28]]},"reference":[{"key":"2025100705473672000_105.23.1806.1","unstructured":"Mendis S , Puska P , Norrving B . 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World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases. Geneva, Switzerland, 2013."},{"key":"2025100705473672000_105.23.1806.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2017.08.007"},{"key":"2025100705473672000_105.23.1806.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.06.020"},{"key":"2025100705473672000_105.23.1806.16","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0b013e318272153e"},{"key":"2025100705473672000_105.23.1806.17","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia-2016-010758"},{"key":"2025100705473672000_105.23.1806.18","doi-asserted-by":"crossref","unstructured":"Ilarraza-lomel\u00ed H , Garc\u00eda-saldivia M , Rojano-castillo J , et al . National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II). 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