Determinants of patients' participation in cardiac rehabilitation programs: A scoping review

Cardiac rehabilitation (CR) has been shown to reduce morbidity and mortality while enhancing quality of life in patients with cardiovascular disease. Despite these benefits, participation in CR programs remains low globally. This scoping review aimed to map the determinants influencing patients' participation in CR.

A systematic search of peerreviewed publications from 2016 to 2023 was performed. Studies were included if they examined patient-level or system-level determinants affecting participation in Phase II CR. Data was systematically extracted, and the Critical Appraisal Skills Programme checklist was used to assess methodological quality. The findings were integrated and interpreted using thematic analysis and reported in accordance with PRISMA-ScR guidelines.

Ten studies from diverse countries, predominantly cross-sectional, were selected for review. Structural and logistical barriers were most prominent, including transportation issues, distance, inconvenient locations, time constraints, and financial costs. Sociodemographic factors such as older age, lower education, reduced income, unemployment, immigrant status, and family responsibilities were linked to lower participation. Psychosocial barriers included anxiety, limited social support, and preference for self-management. Healthcare system barriers involved lack of referrals, limited physician encouragement, and poor dissemination of information. Knowledge and perceived need barriers were evident, with low awareness, limited understanding of benefits, perceived lack of necessity, and concerns about fatigue, comorbidities, and exercise tolerance. Overall, participation is shaped by complex, interrelated structural, individual, and system-level factors.

Engagement in CR is shaped by a complex interaction of structural, individual, and healthcare system factors. Approaches such as home-based and hybrid CR models, improved referral pathways, and targeted patient education may enhance participation and support better clinical outcomes.