Abstract
Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.
Highlights
Cardiovascular diseases (CVDs) are highly prevalent, and CVD patients have an increased risk of mortality and morbidity, such as rehospitalization, revascularization and other major adverse cardiac events [1,2]
Cardiac rehabilitation (CR) barriers score was unrelated to age and referral indication
Multi-level barriers itators in a low-resource show setting that logistical factors, suchfactors, as cost,such distance and tators in a setting low-resource show that logistical as cost, distance a transportation, those which most affect in CR.professionals
Summary
Cardiovascular diseases (CVDs) are highly prevalent, and CVD patients have an increased risk of mortality and morbidity, such as rehospitalization, revascularization and other major adverse cardiac events [1,2]. The burden is high in low- and middle-income countries; in Colombia, for example, CVD continues to be the leading cause of death [3], causing 26% of total deaths [3]. It is the second leading cause of death and disability (DALYs) combined in Colombia [3,4]. Cardiac rehabilitation (CR) is a comprehensive outpatient program of exercise and education, designed to improve lifestyle, control risk factors and implement secondary prevention recommendations [6]. Participation in these programs is associated with an approximately 20% lower morbidity and cardiovascular mortality [7], and reduced healthcare costs
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