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.

For a list of Dr. Grace's publications, please visit PubMed, ORCID, Scopus or Publons.

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