Affordable Cardiac Rehabilitation:

An Outreach Inter-disciplinary Strategic Study (Across)

What is the ACROSS collaboration?

“Ensuring global access to affordable and effective rehabilitation for people with heart disease to enable them to lead longer & healthier lives”

Working with partners in Bangladesh, Pakistan and India, the ‘Affordable Cardiac Rehabilitation: An Outreach Inter Disciplinary Strategic Study’ (ACROSS) programme will develop the infrastructure for development and delivery of clinically effective, affordable and culturally appropriate model of home-based CR. ACROSS is organised in four work packages to be undertaken in the three low and middle income countries (LMICs) – Bangladesh, Pakistan, and India:

Work Package 1

Intervention development

culturally adapt a home-based cardiac rehabilitation (CR) programme developed in United Kingdom.

Work Package 2

Feasibility study

pilot study in each country to determine the feasibility/acceptability of trial design and adapted rehabilitation intervention.

Work Package 3

Full trial

a multi-country full randomised trial to assess the clinical and cost-effectiveness of home-based CR plus usual care versus usual care alone in 3000 patients with coronary heart disease and/or heart failure with depression and/or anxiety with nested economic/process evaluation (trial design).

Work Package 4

Capacity development

build sustainable research and CR delivery capacity and enhance knowledge.

Aims of the Project

Evaluate the impact of a culturally-adapted, affordable, inter-disciplinary CR programme in three LMICs of Southeast Asia (Bangladesh, Pakistan, and India).

Objectives of the Project

Evaluate the impact of patient outcomes (survival, rehospitalisation rates, health-related quality of life, depression/anxiety) through delivery of a culturally-adapted, multidisciplinary CR programme on cardiac patients with co-morbidities.
Evaluate the cost-effectiveness and feasibility of establishing a multidisciplinary CR programme in three LMICs of Southeast Asia.

Research Question

Is the implementation of a culturally-adapted, multidisciplinary, home-based CR programme for patients diagnosed with CVDs and modifiable risk factors, as compared to usual care, is clinically effective and cost-effective when delivered within LMICs of Southeast Asian of Pakistan, India, and Bangladesh?