"It Was a Blur": A Qualitative Study of Barriers to Participation in Cardiac Rehabilitation Among Patients With Heart...

Fewer than 10% of eligible patients with heart failure (HF) participate in cardiac rehabilitation (CR). To identify patient-centered opportunities to improve CR participation rates, we identified factors influencing HF patient decisions to enroll in CR.

We recruited patients with HF referred to CR from the hospital, clinic, or CR program to participate in interviews focusing on the referral process, barriers, and facilitators to participation and general perceptions of CR. Patients who had not yet attended CR were interviewed 8 weeks later to assess CR attendance. Interviews were audio-recorded, transcribed, and analyzed using constant comparative analysis.

We enrolled 18 patients; 5 in CR, 9 referred to CR during a hospitalization, and 4 referred to CR from the clinic. We conducted follow-up interviews with 5 patients. Emergent themes impacting CR attendance included (1) limited memory of inpatient CR referral and education; (2) uncertainty of whether CR is appropriate for them; (3) inconsistent understanding of what CR entails; (4) concerns about symptom burden; (5) fears about safety of exercise; and (6) desire to get healthy and stay alive.

Among patients with HF referred to CR, the timing, content, and quality of CR education and referral appear important for encouraging enrollment. Many patients could not recall documented inpatient conversations about CR, raising questions about the impact of referrals made during hospitalization and discharge for patients with HF. Patients suggested that repetition of education would increase the likelihood of enrollment, along with support to address health-related social needs and eligibility specific to the HF population.