Investigating Patient Barriers to Attending Cardiac Rehabilitation Post-Discharge

Investigating Patient Barriers to Attending Cardiac Rehabilitation Post-Discharge

Cardiac rehabilitation (CR) is a comprehensive program that helps patients recover from cardiovascular events, such as heart attack or bypass surgery, and prevent further complications. CR involves supervised exercise, education, counseling, and lifestyle modification. CR has been shown to reduce mortality, morbidity, hospitalization, and health care costs, as well as improve quality of life and psychological well-being (Anderson et al., 2016).

However, despite the proven benefits of CR, many patients do not participate in or complete the program. According to a recent study by Turk-Adawi et al. (2020), only 46% of eligible patients were referred to CR, and only 26% of those referred actually attended. Moreover, among those who attended, the average dropout rate was 24%. These low rates of referral, attendance, and completion indicate that there are significant barriers that prevent patients from accessing and benefiting from CR.

The purpose of this blog post is to explore some of the common barriers that patients face when it comes to attending CR post-discharge, and to suggest some possible solutions to overcome them. The barriers can be categorized into four main types: patient-related, provider-related, system-related, and program-related.

Patient-related barriers are those that stem from the patient’s personal characteristics, preferences, beliefs, or circumstances. Some examples of patient-related barriers are:

– Lack of awareness or knowledge about the benefits and availability of CR
– Low motivation or self-efficacy to engage in physical activity and lifestyle changes
– Fear or anxiety about exercising after a cardiac event
– Perceived low severity or risk of their condition
– Competing priorities or responsibilities, such as work or family
– Financial constraints or lack of insurance coverage for CR
– Transportation difficulties or distance to the CR center
– Cultural or linguistic differences or preferences

Provider-related barriers are those that originate from the health care professionals who are involved in the patient’s care, such as physicians, nurses, or allied health staff. Some examples of provider-related barriers are:

– Lack of awareness or knowledge about the benefits and availability of CR
– Lack of time or resources to refer patients to CR
– Inconsistent or inadequate communication with patients about CR
– Negative attitudes or beliefs about CR or its effectiveness
– Lack of feedback or follow-up with patients who are referred to or attend CR

System-related barriers are those that pertain to the health care system or the society at large. Some examples of system-related barriers are:

– Limited availability or accessibility of CR programs or services
– Long waiting lists or delays in starting CR
– High costs or fees for CR participation
– Lack of standardization or coordination among different CR programs or providers
– Lack of policies or incentives to support CR referral, attendance, and completion

Program-related barriers are those that relate to the specific features or characteristics of the CR program itself. Some examples of program-related barriers are:

– Inconvenient or inflexible schedule or location of CR sessions
– Mismatch between the patient’s needs or preferences and the program’s content or format
– Lack of individualization or tailoring of the program to the patient’s goals or abilities
– Poor quality or delivery of the program by the staff or instructors
– Lack of social support or interaction with other participants or staff

To address these barriers and increase the uptake and adherence of CR post-discharge, several strategies have been proposed and tested in the literature. Some of these strategies are:

– Educating and counseling patients and providers about the benefits and availability of CR
– Enhancing motivation and self-efficacy of patients through goal-setting, feedback, and reinforcement
– Reducing fear and anxiety of patients through reassurance, relaxation techniques, and gradual exposure to exercise
– Providing financial assistance or subsidies for low-income patients or those without insurance coverage for CR
– Offering transportation services or vouchers for patients who have difficulty accessing the CR center
– Adapting the program to suit the cultural or linguistic needs or preferences of diverse patient populations
– Improving communication and coordination among health care professionals involved in the patient’s care
– Implementing policies or incentives to encourage referral, attendance, and completion of CR
– Increasing availability and accessibility of CR programs or services through alternative delivery modes, such as home-based, community-based, telehealth-based, or web-based CR
– Enhancing flexibility and individualization of the program to match the patient’s schedule, location, goals, abilities, and preferences
– Improving quality and delivery of the program by training and supervising staff and instructors
– Fostering social support and interaction among participants and staff through group sessions, peer mentoring, online forums, etc.

By implementing these strategies, health care professionals can help overcome the barriers that prevent patients from attending CR post-discharge, and thus improve their outcomes and quality of life.

References

Anderson L., Oldridge N., Thompson D.R., Zwisler A.D., Rees K., Martin N., & Taylor R.S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology, 67(1), 1-12. https://doi.org/10.1016/j.jacc.2015.10.044

Turk-Adawi K., Supervia M., Lopez-Jimenez F., Pesah E., Ding R., Britto R.R., Bjarnason-Wehrens B., Derman W.E., Abreu A., Babu A.S., Buckley J.P., Chen S.L., Chen T.M., Chirkov Y.Y., Chow C.K., Doherty P., Farsky S.J., Gonzalez G., Grace S.L., … & Grace A.A. (2020). Cardiac rehabilitation availability and density around the globe. EClinicalMedicine, 24, 100395. https://doi.org/10.1016/j.eclinm.2020.100395