Affordable Cardiac Rehabilitation: An Outreach Inter-disciplinary Strategic Study (ACROSS)


What is the ACROSS collaboration? | Home

“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.


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


  1. 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.
  2. Evaluate the cost-effectiveness and feasibility of establishing a multidisciplinary CR programme in three LMICs of Southeast Asia,


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?