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All About the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR)

Dear TAPMR Members:

This information is intended for those of you interested in the cardiac area. As the current Chair of ICCPR, I am writing on behalf of our Executive to formally introduce ourselves, share with you our history, and inform you of our activities. It is only by engaging interested cardiac providers, that we can all achieve our mission to improve chronic cardiac care and patient outcomes globally.

Did you know years ago there was a “World Council of Cardiac Rehab”? They held their last conference back in 2004 in Dublin, Ireland. The council served an important purpose of bringing together cardiac rehab (CR) professionals around the world, but unfortunately ran out of funds and disbanded.

ICCPR was “born” around 2010. We hosted a series of meetings with the leads of many of the CR societies globally, to talk about ways to again formally work together and formulate our shared mission. This resulted in our international Charter (published in our association journal JCRP volume 33[issue 2] in 2013;https://journals.lww.com/jcrjournal/Fulltext/2013/03000/International_Charter_on_Cardiovascular_Pre vention.10.aspx), which was endorsed by 15 CR or like-minded societies.

This coalition of associations then went on to become a formal member of the World Heart Federation (WHF). We are a Council comprised of named representatives from the Board of Directors of member associations (such as Dr. Ssu-Yuan Chen from Taipei; and Marta Supervia of ESPRM’s CR special interest group). We are currently 34 association members strong (see Figure 1), with good coverage across all corners of the globe. We also recently added a member category of “friends”, for those colleagues in countries CR is burgeoning, yet no CR-type association exists to formally join us; we have 11 such friends as official members. We meet via webconference quarterly, and meet in-person biennially in conjunction with WHF’s conference (World Congress of Cardiology).

You might be interested in perusing our website at www.globalcardiacrehab.com. There we collate the resources of all our member associations, including links to CR guidelines, registries, training opportunities, quality indicators / performance measures, standards, as well as newsletters. If you know of additional resources with global applicability you feel we have missed, please let us know.

KEY ICCPR PROJECTS:

ICCPR has led, been involved with, or showcased other, seminal reviews in the CR area, summarizing for example CR benefits, registries, national CR delivery, costs & cost-effectiveness, and quality in all countries around the world (see our website).

Our members told us what they really needed was advocacy for more delivery. Hence, we surveyed all countries to determine what were the CR reimbursement sources around the world, and secured “success stories” from countries with better reimbursement and capacity (see BMC HSR, volume 16, 2016) to circulate along with our advocacy toolkit (http://globalcardiacrehab.com/advocacy/). We also advocate for CR through our participation in World Health Organization’s Rehab2030 initiative
(http://www.who.int/disabilities/care/rehab-2030/en/) they are developing a package of rehabilitation interventions, inclusive of rehab for ischemic heart disease.

Using the most rigorous of methods, we convened an international panel of experts through our extensive network and developed a consensus statement on CR delivery in low-resource settings. It is available on ECRI’s Guideline Clearinghouse (https://guidelines.ecri.org/; in addition to being published in Heart & Progress in CVD). In the statement, we put forward recommendations on how to deliver each CR core component in an evidence-based, affordable and feasible manner.

We have a companion certification program, trainees can view a module corresponding to each core component, to increase capacity to deliver CR in low-resource settings
(see: http://globalcardiacrehab.com/training-opportunities/certification/). Approximately 1,000 cardiologists in India recently completed the certification, earning the CRFC designation.

We also undertook a survey of every CR program around the world! Overall, 112/203 (54.7%) countries in the world offer CR, of which we collected data in 93 (N=1,081 programs completed surveys). Results of the study are now being disseminated (see for example https://www.mdpi.com/2077-0383/7/9/260 and https://www.sciencedirect.com/science/article/pii/S0167527318343894?via=ihub). We have for the first time quantified the number more CR spots needed in each country, and what is delivered it is available.

Finally, our most recent initiative has been around increasing CR utilization. We have d the Cochrane review on interventions to increase CR utilization (to be released Feb 1). We found interventions that significantly increase CR enrolment, adherence and completion (resources collated here: http://sgrace.info.yorku.ca/tools-to-promote-cardiac-rehabilitation-utilization/). Based on the evidence, we convened an international writing panel to put forward a joint ICCPR and CACPR position statement. We have received endorsement from ~20 CR societies globally to date, including TAPMR, and hope it will be published soon.

We have developed an online course for inpatient cardiac healthcare providers regarding how to promote CR use in their patients, to facilitate implementation of statement recommendations. See:
http://learnonthego.ca/Courses/promoting_patient_participation_in_CR/story_html5.html. Once we are done evaluating it, we will genericize the referral information to be applicable to any location, and disseminate it more broadly.

In closing, we hope you will find ICCPR to be a companion resource to all that TAPMR offers you, bringing you ideas and perspectives from all corners of the globe. If you are ever looking for CR contacts, resources etc. in another part of the world, please do not hesitate to reach out to us.

Sincerely,

Sherry L Grace, PhD, FCCS, CRFC
Chair, ICCPR
Member, CACPR, AACVPR & EAPC
Professor, York University & Director of CR Research, University Health Network, Toronto
globalcardiacrehab@gmail.com

ICCPR_GlobalCR & @sherrylgrace