Cardiac Rehabilitation Program-Related Factors Associated With Morbidity Among Patients in Low-Resource Settings: Analysis From the International Cardiac Rehabilitation Registry

Abstract

Purpose: Cardiovascular disease is a leading cause of morbidity globally, particularly in low-resource settings. The effectiveness of cardiac rehabilitation (CR) is well-established; however, the nature of services in low-resource settings differs. This study sought to investigate program characteristics associated with lower all-cause morbidity among CR participants from low-resource settings.Methods: This was a prospective observational study analyzing the International Council of Cardiovascular Prevention and Rehabilitation's International CR Registry. Programs with annual assessment data at the time of study were included, and their characteristics were assessed in a survey. Self and program-reported patient morbidity included all- and cardiac-cause hospitalization, emergency department visits, cardiovascular disease events, and procedures 1 year from initial assessment. A multilevel modified Poisson regression model was used to account for clustering of patients within CR programs, estimating the adjusted incidence rate ratios (IRR) for morbidity.Results: Of the 690 patients from programs in 6 countries across 4 regions (Colombia, Iran, Malaysia, Mexico, Pakistan, and Qatar), 637 (92) were retained, of which 479 (75) had morbidity data. Seven patients died and 93 suffered morbidity; this was most commonly noncardiac hospitalization (29 events) and emergency department visits (18 events). The regression analysis revealed a significantly lower incidence of morbidity associated with the following program factors: higher number of risk factors assessed (IRR = 0.55: 95 CI, 0.39-0.77), greater number of CR health care professionals (IRR = 0.76: 95 CI, 0.65-0.89), and CR located in academic/tertiary care institution (IRR = 0.61: 95 CI, 0.50-0.75).Conclusion: Globally, CR programs could benefit from prioritizing comprehensive risk assessment and strengthening CR teams to potentially reduce morbidity.