Development and Evaluation of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) Program Certification for Low-Resource Settings

Abstract

Background

Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation’s (ICCPR) Program Certification and (2a) tested its implementation, considering (b) appropriateness of quality standards for these settings.

Methods

The Steering Committee finalized 13 standards, requiring 70% be met. They are assessed initially through International CR Registry (ICRR) program survey and patient data; if Certification appears possible, a two-hour virtual site assessment is arranged to corroborate. Standard operating procedures for Assessor training were developed. A multi-method pilot study was then undertaken with a quantitative (description of quality indicators) and qualitative (focus groups on MS Teams) component. ICRR sites with post-program data by April 2022 were invited to participate. Two team members independently analyzed focus group transcripts, using a deductive-thematic approach with NVIVO.

Results

Five CR programs from the Eastern Mediterranean, South-East Asian and American regions participated. Upon application, with some data cleaning, initially four programs were eligible to proceed to virtual site assessment. Ultimately, all five programs were certified, each meeting a minimum of 12/13 standards (peak MET increase and program completion rate were not met by some centres). Four themes resulted from the two focus groups of 13 site data stewards: motivation and benefits (eg, international recognition, additional program resources), logistics (eg, communication, cost, site visit process), the standards and their assessment (eg, balance of rigor and feasibility), and suggestions for improvement (eg, website).

Conclusion

ICCPR’s Program Certification has been demonstrated to be feasible, rigorous, and acceptable. Standards are attainable in low-resource settings. Certified programs reap benefits including additional resources. This first international Certification is suitable for low-resource settings, to complement that from the American and European CR Societies.

Keywords:

• quality of care
• Certification
• cardiac rehabilitation
• low- and middle-income countries
• registries
• cardiovascular diseases

Abbreviations

CVD, Cardiovascular disease; LMICs, Low and middle-income countries; DALY, Disability adjusted life years; CR, Cardiac rehabilitation; ICCPR, International Council of Cardiovascular Prevention and Rehabilitation; ICRR, International Cardiac Rehabilitation Registry; BACPR, British Association for Cardiovascular Prevention and Rehabilitation; AACVPR, American Association of Cardiovascular and Pulmonary Rehabilitation; EAPC, European Association of Preventive Cardiology; METs; Metabolic equivalents of task; JCI, Joint Commission International.

Data Sharing Statement

The datasets generated and/or analysed during the current study are not publicly available. For the qualitative part, due to the small number of interviewees, participant identity could be identified. For the quantitative component, agreement to share data by participating sites in the ICRR was not obtained. Data are available from the corresponding author on reasonable request.

Acknowledgments

We are grateful to ICCPR’s former Secretary Ms. Carol Tran for implementation of the standard operating procedures with pilot programs. We are also grateful to the other members of ICCPR’s Program Certification steering committee, namely Drs. Jonathan Gallagher, Diann Gaalema, Won-Seok Kim, and Abraham Babu, as well as Mr. Jonathan David. We also thank the International Cardiac Rehabilitation Registry (ICRR) site data stewards for their efforts which under-propped this work, including notably Drs. Masoumeh Sadeghi, Jorge Antonio Lara Vargas, Theodoros Papasavvas, and Anjali Zende.

Disclosure

AC serves on the Program Certification Steering Committee and also put his program forward for certification consideration. To mitigate any conflict, assessment of his site’s data and the virtual site assessment were handled by other members of the committee without communication with AC until the decision had been reached. Two other authors were involved in this paper and their site was assessed, however they did not play a role in assessing their own site or have access to their certification data. Otherwise, the authors declare that they have no conflicts of interest.

Additional information

Funding

The International Cardiac Rehab Registry was co-funded by Qatar University, grant number (IRCC-2020-005), and York University (no grant number). E.E.T. is funded by a fellowship from the National Heart Foundation of Australia (105215). The findings achieved herein are solely the responsibility of the authors.