Impact of a multicomponent strategy on utilization of cardiac rehabilitation services in a tertiary care hospital from a lower middle-income Country: A retrospective analysis

Abstract

Context: Globally, uptake of cardiac rehabilitation (CR) is low, more so in lower middle-income countries (LMICs) compared to developed nations. LMICs share a greater burden of cardiovascular diseases, and hence, there is an urgent need for enhancing CR services. Aims: The objective of this retrospective study was to describe a multicomponent strategy employed in a tertiary care hospital from an LMIC and to improve CR services and its impact on CR availability, uptake, and barriers. Materials and Methods: To ensure the CR availability and uptake, a multi-component strategy involving sensitization of all concerned health-care team members about the importance and need of CR, strengthening infrastructure and resources, laying down appropriate clinical pathways, and culturally adapting standard guidelines and protocols were put in place. For the present retrospective analysis, utilization of CR services by patients diagnosed with coronary artery disease (CAD) was extracted from the medical records of the hospital. Results: Between February 2017 and December 2017, a total of 629 patients with diagnosis of CAD underwent percutaneous transluminous coronary angioplasty (PTCA) (78%) or coronary artery bypass grafting (CABG) (22%). All patients (629) received Phase I rehabilitation (rehab) (100%), 145 patients (23%) received Phase 2 rehabilitation, and 44 patients (7%) received Phase 3 rehabilitation. Residence location, gender, dependency on caregivers, and employment status were identified as barriers to Phase 3 CR uptake. Conclusion: This multi-component strategy positively influenced CR uptake, and a few barriers were identified that need to be addressed. Clinical Implication: Importance of multidisciplinary and multicomponent strategic management to increase the uptake in a CR program.