Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries

Abstract

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.

Keywords: Availability; Health services; Rehabilitation; Upper-middle income country.