Abstract
Background
Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown.
Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized
by province/territory. This study aimed to establish (1) CR volumes, capacity, and
density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory
and (b) with other high-income countries (HICs).
Methods
In this cross-sectional study, an online survey was administered to CR programs globally.
National cardiac associations were engaged to facilitate program identification where
available, or local champions. Density was computed using Canada’s Chronic Disease
Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs
with CR were selected for comparison (N = 619 programs), and multilevel analyses performed.
Results
CR was available in 10 of 13 (76.9%) provinces (no programs in Canada’s North), with
74 of 182 programs initiating a survey (40.7% response). Program volumes (median =
250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients
with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots
are needed annually. Most programs were funded by government/hospital sources (n =
48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket.
Guideline-indicated conditions were accepted in more than 90% of programs. Programs
had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components
(varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001).
Conclusions
Canadian CR capacity must be augmented, but where available, services are consistent
with other HICs.
Résumé
Contexte
La capacité d’accueil en réadaptation cardiaque au Canada est insuffisante, mais l’ampleur
du besoin non comblé demeure inconnue. De plus, bien qu’il existe des lignes directrices
canadiennes en matière de réadaptation cardiaque, aucune évaluation n’a été effectuée
pour déterminer si les soins prodigués dans chaque province/territoire étaient conformes
à ces lignes directrices. Cette étude visait (1) à déterminer le volume et la densité
des cas de réadaptation cardiaque ainsi que la capacité d’accueil des programmes de
réadaptation; (2) à établir la nature de ces programmes; et (3) à comparer les programmes
(a) par province/territoire et (b) avec les programmes offerts dans d’autres pays
à revenu élevé.
Méthodologie
Dans le cadre de cette étude transversale, un sondage en ligne a été mené auprès de
programmes de réadaptation cardiaque à l’échelle mondiale. Des associations nationales
vouées aux problèmes cardiaques et des champions locaux, là où il y en avait, ont
été contactés pour faciliter le repérage des programmes. La densité a été calculée
à l’aide des estimations de l’incidence de la cardiopathie ischémique du Système canadien
de surveillance des maladies chroniques (SCSMC). Au total, 28 pays à revenu élevé
offrant des programmes de réadaptation cardiaque ont été retenus à des fins de comparaison
(N = 619 programmes), et des analyses multiniveaux ont été réalisées.
Résultats
La réadaptation cardiaque était offerte dans 10 provinces/territoires sur 13 (76,9
%) (aucun programme dans le Nord canadien); 74 programmes sur 182 ont répondu au sondage
(taux de réponse de 40,7 %). Les programmes dont le volume de patients était le plus
élevé (médiane de 250) étaient situés en Ontario, mais, au bout du compte, il n’y
avait qu’une place en réadaptation cardiaque pour 4,55 patients atteints de cardiopathie
ischémique à l’échelle nationale (résultat similaire à celui des autres pays à revenu
élevé), et 186 187 places additionnelles par année étaient requises. La plupart des
programmes étaient financés par un gouvernement ou un hôpital (n = 48; 66,7 %), mais
dans 23 programmes (31,5 %), les patients devaient assumer eux-mêmes une partie ou
la totalité des coûts. Plus de 90 % des programmes acceptaient des patients atteints
d’un trouble cardiaque pour lequel une réadaptation était indiquée, selon les lignes
directrices. Les programmes pouvaient compter sur une équipe multidisciplinaire composée
de 6,2 ± 2,1 membres et offraient 7,7 ± 1,5 composantes clés sur 10 (qui variaient
selon la province, p = 0,001; le volet retour au travail était offert moins fréquemment que dans les autres
pays à revenu élevé; p = 0,03) sur une période de 42,0 ± 26,0 heures (différences entre les provinces et
avec les autres pays à revenu élevé, p < 0,001).
Conclusions
Il faut augmenter la capacité d’accueil en réadaptation cardiaque au Canada; toutefois,
là où les services sont offerts, ils sont similaires à ceux des autres pays à revenu
élevé.
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Article Info
Publication History
Published online: July 26, 2018
Accepted:
July 9,
2018
Received:
May 14,
2018
Footnotes
See page S261 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
