simplified strategies of cr in low-resource settings: perspectives from iccpr
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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. - PowerPoint PPT PresentationTRANSCRIPT
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Simplified Strategies of CR in Low-Resource Settings:
Perspectives from ICCPRSherry L. Grace, PhD
Secretary/Treasurer, ICCPRFull Professor, York University
Director of Research, Cardiac RehabUniversity Health Network
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Disclosure Statement of Financial Interest
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.
3WHO Global Atlas CVD Prev & Control,2011
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Availability of CR Globally
Adawi et al., (accepted in principle) Nature Reviews:
Cardiology
Global Availability of CR by Country Income Classification
High-income countries: 68.0% (51/75 countries)
Middle-income countries: 28.2% (29/103 countries)Low-income countries: 8.3% (3/36 countries)
Globally: 38.8% (83/214 countries)
LMICs: 23.0%
5Turk-Adawi, K., Sarrafzadegan, N., & Grace, S.L. (accepted in principle). Nature Reviews: Cardiology.
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21 Associations of the
7 1993
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• “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
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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.
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Literature Review: Search Strategy
1. Comprehensive search using Medline and Embasea- cardiac diseasesb- rehabilitationc- LMICs
2. Grey literature search for reports, guidelines
11Buckley et al ., Heart, 2013
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Literature Search ResultsComponent # citationsCR in LMICs 1417CR models 130Psychological therapy 566Obesity 295Lipids 152Blood pressure 215Education interventions 318Smoking cessation 237Nutrition interventions 274
Alternative Models of CR Delivery
Low-cost, accessible models:Home-based (Dalal etal., 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)
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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
Implementation Considerations
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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
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Acknowledgments• Lit search: Maureen Pakosh, MIst
• Nizal Sarrafzadegan, MD (co-chair)
• Contact: [email protected]
• Funding: