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Updated: Jun 21, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Challenges and solutions to implementing cardiac rehabilitation in a low- and middle-income country
Abraham Samuel Babu1, Vibha Bhat2, Prinu Jose3
1Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Cardiac rehabilitation (CR) is underutilized in low-income countries. Healthcare professionals identified challenges like poor referrals and infrastructure, suggesting improved awareness and task sharing are key to increasing CR implementation.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- Cardiac rehabilitation (CR) is significantly underutilized globally, particularly in low- and middle-income countries (LMICs).
- Understanding healthcare professionals' (HCPs) perspectives is crucial for identifying barriers to CR implementation.
Purpose of the Study:
- To explore the challenges and inadequacies perceived by HCPs regarding the implementation of CR in India.
- To identify potential strategies for improving CR utilization in a LMIC setting.
Main Methods:
- Qualitative study employing in-depth interviews.
- 18 HCPs (physicians, physiotherapists, nurses) with extensive CR experience were interviewed.
- Participants represented diverse hospital settings (private, government, teaching, non-teaching) in India.
Main Results:
- Key challenges included lack of referrals, perceived lack of CR benefit, and inadequate hospital/health system infrastructure.
- Identified inadequacies involved insufficient CR competencies, limited task sharing, and poor human resource utilization.
- Suggested solutions focused on enhancing awareness and competencies, facilitating task sharing, and integrating CR into holistic care.
Conclusions:
- The study highlights significant barriers to CR implementation in India, as perceived by HCPs.
- Strategies addressing awareness, competency, task sharing, and holistic care models are recommended to improve CR uptake.
Background:
Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs).
Research Design And Methods:
This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India.
Results:
The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India.
Conclusions:
Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC.
Trial Registration:
www.ctri.nic.in with identifier CTRI/2020/07/026807.
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