Cardiac rehab participation low in SG, collaborative efforts needed
Nationwide collaborative efforts are necessary to highlight the importance of cardiac rehabilitation (CR), said Dr Yeo Tee Joo, Consultant Cardiologist at the National University Heart Centre, Singapore, calling for efforts to increase awareness of CR benefits, utilization of technology, and formation of support groups for patients.
“The burden of heart disease in Singapore is high ... [and] the benefits of CR are undeniable,” stressed Yeo during the recent SPCRS 2017.
Being highlighted was a global survey of CR programmes conducted through a joint collaboration between the International Council of Cardiovascular Prevention and Rehabilitation, the Mayo Clinic, and Singapore. The cross-sectional study involved a confidential online survey, with the respective national cardiac associations helping to identify CR programmes available in the country.
“CR participation rate [in Singapore] was 9.7 percent based on hospital discharge figures for ischaemic heart disease,” observed Yeo, noting that this rate was similarly low compared with high-income countries (12.2 percent in US, 5.0 percent in Korea) and middle-income countries (14 percent in Thailand and 20 percent in the Philippines). “Despite the overwhelming benefits, CR participation rates are dismal worldwide,” he added.
The most common barriers to the delivery of CR programmes, as cited by 43 percent of the respondents, included the lack of patients’ referral, shortage of human resources, and the patients' inability to attend CR due to other commitments.
“Alternative CR model which may mitigate these barriers such as home-based programmes were not offered [by] any CR programmes in Singapore,” said Yeo.
Home-based CR has been shown to improve maximum volume of oxygen uptake (VO2 max) by 1.6 mL/kg/min and the total Minnesota Living with Quality of Life score vs usual care (no CR), with no difference in mortality and hospitalization ─ suggesting that home-based CR is safe and may be an alternative to the conventional centre-based CR, according to a meta-analysis of home-based CR for people with heart failure. [Int J Cardiol 2016;221:963-969]
Another alternative relies on technological advances involving telehealth exercise-based CR (exCR), said Yeo. Telehealth exCR has been shown to better enhance physical activity level, exercise adherence, and improve cardiovascular risk factors such as LDL cholesterol and diastolic BP than centre-based CR. [Heart 2016;102:1183-1192]
“Nationwide collaborative efforts are imperative to highlight the importance of CR and improve resource allocation,” said Yeo. “Increase awareness, implementing home-based CR, utilization of technology, setting nationwide standards for CR provision, and creating patient support groups [can potentially help overcome some of the barriers to CR participation].”
The seven institutes involved in the study were National University Heart Centre, National Heart Centre Singapore, Tan Tock Seng Hospital, Changi General Hospital, Khoo Teck Puat Hospital, Ng Teng Fong General Hospital, and Singapore Heart Foundation.
According to Yeo, the very first CR programme in Singapore started as early as 1979.