Heart disease is the leading cause of death globally. Due to advances in acute treatments, many patients survive a first heart attack or event. Therefore, there are a large number of people around the world living with a chronic heart problem.

Patients with heart problems are at high risk of another heart attack or heart problem, and their risk of dying is great. Therefore, it is recommended heart patients attend cardiac rehabilitation (CR). CR is an outpatient chronic disease management program, promoting heart-health behaviour changes such as exercise, diet and smoking cessation, as well as risk factor management and psychosocial well-being. Participation in CR results in improved quality of life, less re-hospitalization and 25% less death, compared to patients who do not participate.

Unfortunately, research demonstrates that only 40% of patients have access to CR, and this is even lower in women and ethnocultural minorities, among other groups. Rates are even lower in low- and middle-income countries, where there is an epidemic of heart disease. There are a combination of factors relating to patients (e.g., transportation barriers, work and family obligations), physicians (e.g., failure to refer), and the health care system itself (e.g., lack of programs, insufficient resources) that lead to low CR use.

The objectives of Professor SL Grace's program of research are to: (1) address barriers to CR participation so we can reach and treat all heart patients, and (2) to evaluate and broadly deliver a low-cost model of CR.

This has involved, for example, establishing that systematically referring all heart patients to CR in the hospital before they go home, results in over 8 times more patients accessing CR. This research formed the basis of a national policy position on CR referral and the establishment of national CR quality indicators. Another line of study involved the development of a scale to measure CR barriers; this scale is now being used around the world to identify patients barriers, which can then be mitigated to achieve greater CR use. Finally, Professor Graces work has also been instrumental in understanding the delivery of CR provincially, nationally and globally, and the impact of this delivery on patient health. For example, she has shown that only 2/3rds of high-income countries even offer CR, and that CR as delivered in low-income countries also results in improved outcomes for patients. Through her service to major cardiac societies from a national to international level, she works to ensure gaps in CR care are recognized and addressed.
 
Eur J Prev Cardiol. 2019 Feb 20;:2047487319827453
Abreu A, Pesah E, Supervia M, Turk-Adawi K, Bjarnason-Wehrens B, Lopez-Jimenez F, Ambrosetti M, Andersen K, Giga V, Vulic D, Vataman E, Gaita D, Cliff J, Kouidi E, Yagci I, Simon A, Hautala A, Tamuleviciute-Prasciene E, Kemps H, Eysymontt Z, Farsky S,...
J Clin Med. 2019 Feb 16;8(2):
Moghei M, Reid RD, Wooding E, Melo Ghisi G, Pipe A, Chessex C, Prince SA, Blanchard C, Oh P, Grace SL
BMJ Open. 2019 Feb 13;9(2):e026121
Gagliardi AR, Dunn S, Foster A, Grace SL, Green CR, Khanlou N, Miller FA, Stewart DE, Vigod S, Wright FC
J Clin Med. 2019 Feb 05;8(2):
Pio CSA, Chaves G, Davies P, Taylor R, Grace S
J Cardiopulm Rehabil Prev. 2019 Jan 31;:
Moghei M, Oh P, Chessex C, Grace SL
Heart Lung Circ. 2019 Jan 28;:
Thomas E, Grace SL, Boyle D, Gallagher R, Neubeck L, Cox N, Manski-Nankervis JA, Henley-Smith S, Cadilhac DA, O'Neil A
Cochrane Database Syst Rev. 2019 Feb 01;2:CD007131
Santiago de Araújo Pio C, Chaves GS, Davies P, Taylor RS, Grace SL
Eur J Cardiovasc Nurs. 2018 Dec 14;:1474515118820176
Thomas E, Lotfaliany M, Grace SL, Oldenburg B, Taylor CB, Hare DL, Rangani WT, Dheerasinghe DAF, Cadilhac DA, O'Neil A
J Clin Med. 2018 Dec 04;7(12):
Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, Daou-Kabboul T, Bielecki JM, Alter DA, Krahn M

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Director of Research, Cardiovascular Rehabilitation & Prevention Program, Peter Munk Cardiac Centre, University Health Network
Professor, Kinesiology and Health Science, Faculty of Health, York University
Member, Kinesiology and Health Science, Faculty of Graduate Studies, York University
Adjunct Member, Rehabilitation Sciences Unit, Faculty of Medicine, University of Toronto
Member, Heart & Stroke / Richard Lewar Centre of Excellence, University of Toronto
Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto