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Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR

Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR. Sherry L. Grace, PhD Secretary/Treasurer, ICCPR Full Professor, York University Director of Research, Cardiac Rehab University Health Network.

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Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR

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  1. Simplified Strategies of CR in Low-Resource Settings: Perspectives from ICCPR Sherry L. Grace, PhD Secretary/Treasurer, ICCPR Full Professor, York University Director of Research, Cardiac Rehab University Health Network

  2. I, Sherry Grace DO NOT have a financial interest/arrangement or affiliation with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Disclosure Statement of Financial Interest

  3. WHO Global Atlas CVD Prev & Control,2011

  4. Availability of CR Globally Adawi et al., (accepted in principle) Nature Reviews: Cardiology

  5. Global Availability of CR by Country Income Classification High-incomecountries: 68.0% (51/75 countries) • Middle-income countries: 28.2% (29/103 countries) • Low-income countries: 8.3% (3/36 countries) LMICs: 23.0% Globally:38.8%(83/214 countries) Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (accepted in principle). Nature Reviews: Cardiology.

  6. 21 Associations of the

  7. 1993

  8. “define health system-related opportunities … to access for … rehabilitation … and develop feasible and integrated approaches to apply cost-effective NCD interventions at all levels of health care” 2011; p. 46

  9. CR delivery model for low-resource settings: A consensus statement • Primary Writing Panel • Grace, S.L., Turk-Adawi, K., Contractor, A., Atrey, A., Campbell, N., Derman, W., Ghisi, G.M.G., Hu, D., Lopez, F., Mendis, S.,(WHO) & Sarrafzadegan, N. • Secondary Writing Panel • Buckley, J., Akinroye, K. (WHF), Mola, A., Neubeck, L., Pogosova, N., & Rivas-Estany, E.

  10. Literature Review: Search Strategy 1. Comprehensive search using Medline and Embase a- cardiac diseases b- rehabilitation c- LMICs 2. Grey literature search for reports, guidelines

  11. Buckley et al ., Heart, 2013

  12. Literature Search Results

  13. Alternative Models of CR Delivery • Low-cost, accessible models: • Home-based (Dalaletal., 2010) • Community-based (Mandic et al., 2013) • Use of technology (evidence lacking, weak) • Internet-based (Munro et al., 2013) • telehealth, and mobile (Beatty et al., 2013)

  14. Implementation Considerations • Developing national policies support CR provision • Randomized controlled trials of CR in LMICs • Provide cost-effectiveness data • CR part of integrated cardiology service • Expanding health human resources & service delivery • Integration of CR in the curricula of medical schools • Training of healthcare professionals (“Task-shifting”) • Increasing the hours of operation of existing programs

  15. Next Steps • Literature review • Writing • 2ndary Panel review, revision • Submission to Nature Reviews: Cardiology • WCC 2016 – launch? • Field and feasibility testing in low-resource settings

  16. Acknowledgments • Lit search: Maureen Pakosh, MIst • Nizal Sarrafzadegan, MD (co-chair) • Contact: sgrace@yorku.ca • Funding:

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