Feasibility of cardiac rehabilitation models in Kenya

Abstract

Cardiovascular disease is a major driver of global morbidity and mortality, accounting for approximately 50% of non-communicable disease deaths worldwide [1]. Low and middle income countries account for over 80% of global cardiovascular disease mortality [2], with heart failure (HF) manifesting as a terminal complication. In Sub-Saharan Africa, HF afflicts mostly young and economically active adults and leads to severe impairment in quality of life, and loss of productivity amongst patients, their families and society in general [3, 4]. Cardiac rehabilitation (CR) is a multidisciplinary approach providing physical, psychological and social support to patients recovering from cardiac illnesses such as HF. CR typically involves structured exercises based on an exercise prescription, lifestyle modification, counseling and health education [5]. Amongst patients with HF, CR has been shown to have multiple benefits including reduced hospital readmissions, improved exercise capacity and improvement in overall quality of life [5, 6]. There are two common models for delivering CR: institution-based cardiac rehabilitation (IBCR), and home-based cardiac rehabilitation (HBCR). IBCR and HBCR models are similar in efficacy, and to have comparable low risk profiles [7, 8]. Despite the known benefits of cardiac rehabilitation, global uptake has been slow. It is generally under-prescribed and has low adherence rates [6]. Commonly cited barriers to utilization, and drivers of early participant dropout, are poor referral systems, and inaccessibility of rehabilitation centers [6, 9]. With the exception of high income urban centers, there has been little development of CR in in sub-Saharan Africa [10]. In regions such as Western Kenya, where the burden of HF disease is high, CR programs are non-existent [11