The Relationship Between Need and Capacity for Multidisciplinary Cardiovascular Risk-Reduction Programs in Ontario

Background: Available evidence has demonstrated survival benefits associated with multidisciplinary cardiovascular risk-reduction (CR) (le, cardiac rehabilitation) programs. The degree to which program capacity meets eligible service demands in Ontario is unknown. We sought to estimate the supply-need care-gap associated with CR programs across regions (Local Health Integration Networks [LHINs]) in Ontario. Methods: We conducted a cross-sectional, population-based study during 2006. Administrative data provided estimates of the population eligible for multidisciplinary CR services due to (1) recent cardiovascular hospitalizations and (2) incident diabetes. An Ontario-wide survey of CR programs provided service supply estimates. The coverage rate and the absolute supply-need mismatch were use to quantify the care-gap by LHIN. Results: Based on cardiac hospitalizations alone, 53,270 patients in Ontario in 2006 (508.7 per 100,000) were eligible for CR services; 128,869 patients (1245 per 100,000) would have been eligible if newly diagnosed (incident cases) diabetic patients were included. Capacity for CR services was 18,087 patients, corresponding to 34% coverage of the eligible population (absolute unmet needs of 35,189 individuals) if capacity was entirely dedicated to recent hospitalizations and 14% coverage (absolute unmet needs of 110,782) if services were extended to include incident diabetes patients. Marked variation in disease burden, service capacity, and supply-need mismatch was observed across regions, in which supply was not correlated with need. Conclusion: Despite proved benefits of multidisciplinary CR programs, unmet population needs remain high in Ontario and are unequally distributed across regions. The magnitude of unmet needs and the lack of correlation between supply and disease burden necessitate broader provincial strategies to plan, allocate, and subsidize CR programs.