About Us
ACROSS (Affordable Cardiac Rehabilitation: An Outreach Interdisciplinary Strategic Study) is a global research programme funded by the National Institute for Health and Care (NIHR) Research on Interventions for Global Health Transformation (RIGHT) programme led by the University of Glasgow in partnership with various universities and healthcare organisations in the UK, Bangladesh, India and Pakistan.
Why is this research important?
Cardiovascular disease (CVD) is the most prevalent non-communicable disease, the leading cause of global mortality, and a major contributor to premature disability and ill-health. CVD causes an estimated 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years lived with disability [ref]. By 2030, it is estimated that >80% of CVD-related disability and death will occur in low and middle-income countries (LMICs) due to increasing risk factors (e.g., hypertension, smoking, diabetes, obesity) [ref]. South Asia, where the ACROSS programme will be delivered contributes to the highest proportion of CVD burden compared to other regions globally [ref].
The combination of heart disease alongside depression and anxiety is a common and profound unmet need for global health systems, especially in LMIC country settings. The addition of a mental health problem is associated with a 40–50% increased risk of mortality and major cardiac events and a 30–50% reduction in health-related quality of life (HRQoL) in people with heart disease [ref].
Rehabilitation, ‘the action of restoring someone to health or normal life after illness’ is recommended by the World Health Organisation (WHO) as a core component of health services [ref]. Rehabilitation includes exercise, education, and psychological support. It has proved to reduce death rate and hospital admissions and improve the quality of life and mental well-being. However, due to financial limitations and lack of appropriately trained health care personnel, the availability of rehabilitation services in low- and middle-income countries are currently very sparse.
The overarching aim of the ACROSS programme is the evaluation and implementation of a sustainable and scalable culturally and contextually adapted and affordable model of home-based rehabilitation for people with the multimorbidity that includes heart disease and a mental health disorder. |
Specific research objectives
- To co-design with key stakeholders a culturally and contextually adapted affordable home-based rehabilitation programme with low intensity inventions for depression and anxiety
- To co-design ACROSS delivery training for health professionals including a train-the-trainer programme to enable the cascade of training
- To assess the feasibility and acceptability of implementing the ACROSS programme and trial design and examine the parameters and processes of a full-scale trial, including recruitment, randomisation, and retention
- To determine the clinical effectiveness (hierarchical primary outcome of mortality, hospital admission, and health-related quality of life) of the ACROSS programme
- To determine cost-effectiveness of the ACROSS programme in terms of an incremental cost per quality adjusted life year
- To build research and clinical delivery capacity and capability and support south-south partnership and learning to underpin the scalable and sustainable country-wide provision of rehabilitation service
- To embed community and stakeholder engagement to inform the route to impact of the project outputs and findings
Global ACROSS Study Protocol
Our Study Protocol is outlined in this NIHR Open article.
Methods - ACROSS Work Packages
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