Cardiac rehabilitation in Egypt
Authors: Ghada Selim
Journal: The Lancet Global Health (2013)

In a developing country such as Egypt, poor education and living standards are substantial barriers to patients' health knowledge, risk-factor modification, and adherence to medications. Patients with coronary heart disease are in great need of a rehabilitation service to help them to return to their activities and maintain safe exertion levels. Cardiac rehabilitation programmes are highly cost effective and should be at the forefront of the Egyptian Ministry of Health and Population's agenda. However, until recently, no such programmes existed in the public sector. With a financial crisis that has evolved since the revolution in 2011, leaving a health-care system that struggles to ensure the availability of necessary health-care services for the population, we sought to set up a free cardiac rehabilitation programme—the first in Egypt—in Ain Shams University Hospital, which serves around 6000 patients with cardiac problems every year. The set-up process can be divided into five phases. First, we undertook a process of self-education (because exercise prescription and training were new to our cardiologists) and then recruited and trained psychiatrists, nutritionists, and sexual consultants to understand concepts of cardiac rehabilitation and the needs of patients with cardiac problems. Workshops and seminars were hosted in medical departments of interest and relevant national congresses to discuss the programme's cornerstones and cost-effectiveness. Second, we raised funds to purchase equipment by addressing corporate social responsibility as well as targeting individuals. Later, in January, 2013, the cardiac rehabilitation visits were officially priced by the supreme council of hospitals at less than US$2 per visit, a sum that was sufficient to cover running costs and expenses without depending totally on donations. Third, we addressed organisational aspects and prepared illustrated educative materials and videos. Fourth, we set the exercise protocol; selection of patients according to risk and mode of exercise was crucial in a low-resource setting. At this point, the objective was to enrol target patients in an educative programme while selecting low-risk patients for exercise training. Later, with the purchase of monitoring equipment, high-risk patients were enrolled and a heart failure clinic was established. Lastly, we worked with the School of Business at the American University in Cairo to improve service quality with low financial resources. We were provided with a business plan, a fundraising plan, a template (standard operating procedure) to ensure that all staff were aligned in their operations and to promote programme monitoring and auditing, and a computerised data entry application for easier recall of patients' data (we had no electronic archiving system). This application also served as a database for charity institutions that were interested in supporting such patients and their families. So far, 1800 patients have enrolled for education and counselling and 850 for a twice-weekly 8-week exercise programme. Early data show substantial improvement in the awareness of cardiovascular risk factors, adherence to medications, and major adverse cardiac events. We hope to implement expansion plans to enrol more patients. Good finances are essential, but a shortage of money should not hold anyone back. A cardiac rehabilitation programme can be set up and implemented in a low-resource setting, provided staff have the motivation and concern required. I declare that I have no conflicts of interest.