Listening to the patient voice on home-based cardiac rehabilitation: a qualitative audit mapping patient-reported outcomes to current european guidelines

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NHS Lothian. Background and Purpose Increasing evidence supports the efficacy of facilitated home-based cardiac rehabilitation as an alternative to hospital-based rehabilitation for individuals recovering from myocardial infarction and revascularisation. The objective of this audit was to explore qualitative patient-reported outcomes of a home-based cardiac rehabilitation programme in relation to current european guidelines. Methods Following their participation in the six-week cardiac rehabilitation programme, patients completed an evaluation questionnaire consisting of 1) a 25-item survey rating their satisfaction with elements of the programme and 2) five open-ended questions regarding their experiences and resulting outcomes. The anonymous patient responses were transcribed and stored securely using an electronic database. For the purpose of this audit, the qualitative data from 203 patients between April 2021 and January 2023 were analysed. The data was coded into the key risk, psychosocial and behavioural factors presented in current european guidelines, while also capturing additional themes. Once identified, inductive thematic analysis was employed to extract further meaning from featured codes. Results Deductive coding identified the following constructs from the guidelines within the data: risk factors (blood pressure, cigarette smoking, diabetes mellitus, adiposity), sex and gender and their impact on health, communication of cardiovascular disease risk, psychosocial factors, optimising lifestyle (physical activity and exercise, and nutrition and alcohol) and medication adherence. Within this, inductive themes that emerged included: successful risk modification (of factors such as diabetes and adiposity), successful behaviour modification, increased awareness, understanding and confidence, decreases in stress and anxiety, increased pacing and relaxation, preference for more content, resentment of generalised information, the impact of Covid-19 and the benefit of the programme to family members. Conclusions The results of this qualitative audit suggest that patient satisfaction was high, post-participation in the cardiac rehabilitation programme. The findings of reported successful risk and behaviour modification in relation to nutrition, exercise, smoking, alcohol intake, diabetes, adiposity and psychological factors indicate the programme’s efficacy in facilitating lifestyle changes amongst cardiac rehabilitation patients with multiple conditions. The preference for more content with regard to blood pressure and factors specific to women provides valuable insight for ongoing resource development and research.