Race and Sex Inequalities in Cardiac Rehabilitation: Perspectives from UK Healthcare Professionals - A Delphi Study

Cardiac rehabilitation (CR) provides proven benefits, yet only 50% of eligible individuals participate, with females and ethnic minority groups being particularly underrepresented. This study aimed to explore healthcare professionals' (HCPs) views on factors influencing referral and attendance to phase III CR services in the United Kingdom (UK), with the purpose of identifying evidence-based recommendations and strategies to enhance access and participation.

Thirty-eight HCPs involved in the cardiac care or rehabilitation of patients with coronary heart disease (CHD) participated in a three-round Delphi study. Participants were asked about staff competencies, CR core components, referral criteria, referral pathways, and the impact of sex and ethnicity on referral and attendance.

108 statements were proposed by the participants. Consensus was achieved on 53 statements covering 10 key aspects of CR. HCPs identified significant disparities in referral practices and attendance, attributing these to HCP knowledge gaps, lack of streamlined referral pathways, and non-inclusive referral processes. They emphasised the need for educational initiatives within general practitioner surgeries and the development of direct referral pathways to improve CR access. Additionally, HCPs highlighted the importance of educating ward staff on inclusive practices and cultural sensitivity to improve referrals, particularly for females and ethnic minority groups.

The study highlights disparities in CR referral and attendance, particularly by sex and ethnicity. It provides evidence-based recommendations to ensure equitable access to CR services. Future interventions should focus on tailored education for HCPs and streamlined, direct referral pathways to ensure inclusive access for diverse populations in the UK.