Barriers to cardiac rehabilitation use in Canada versus Brazil.

PURPOSE: Despite its well-established benefits, cardiac rehabilitation (CR) is greatly underutilized globally. Barriers to its utilization have been identified in high-income countries. Given the growing epidemic of noncommunicable disease in low-to-middle income countries, the identification of barriers to use of these low-cost interventions is warranted. The aim of this study was to describe and compare barriers to cardiac rehabilitation (CR) use in Brazilian and Canadian cardiac outpatients. METHODS: Two cardiac samples consisting of 237 Brazilian (recruited from 2 CR centers in Southern Brazil) and 1434 Canadian (recruited from 11 community and academic hospitals in Ontario) outpatients were compared cross-sectionally. Barriers were assessed using the Cardiac Rehabilitation Barriers Scale (CRBS), psychometrically-validated in English and Portuguese. Mann-Whitney U tests were used to compare barriers between samples. RESULTS: Overall, 139 (58.6%) Brazilian and 779 (54.3%) Canadian respondents were enrolled in CR. The mean total barriers score for Brazilian respondents was 1.71±.63 and 2.37±1.0 (P<.001) for the Canadians. For 17/21 barriers, Canadians reported significantly greater barriers than Brazilians (P<.02). As their greatest barriers, Canadians rated already exercising at home/community and persona travel, while Brazilians identified distance to and cost of the CR program. CONCLUSION: Despite the significantly lower availability of CR in Brazil and the universal healthcare system in Canada, cardiac outpatients in Canada perceived significantly greater CR barriers. Arguably however, these barriers were more modifiable