Patient perceived barriers to phase II cardiac rehabilitation in patients with and without percutaneous coronary angioplasty

Abstract

Context: Cardiac Rehabilitation is an accepted standard of care after any cardiac event and is considered a class ɪ indication following myocardial infarction or revascularisation procedures. It aims at the reduction of cardiovascular risk factors and improves quality of Life by promoting healthy behavior and an active lifestyle. However, despite its proven benefits and need, it is highly underutilized. Hence this study aims to explore the barriers perceived by patients who were conservatively treated and with percutaneous coronary intervention to attend outdoor cardiac rehabilitation services. Settings and Design: Observational study at the cardiology unit of a tertiary health care hospital. Methods and Material: The barriers perceived by the patients were studied using the interview method using Cardiac Rehabilitation Barrier Scale (CRBS). A complete enumeration sampling technique was used for the enrolment of subjects. The primary outcome measure was to analyse the sub-questions of all four domains of CRBS and compare the difference in the distribution of barriers between conservatively managed and PCI using the Mann-Whitney U test. Results: 216 patients were enrolled, out of which 123 were managed conservatively and 93 underwent Percutaneous Coronary Intervention. Lack of awareness about CR was found in 128 patients (59.25%), Distance and transportation problems were found in 117 patients (54.16%) in the conservative group, and 101 patients in PCI (46.75%). Work time conflict was observed in 117 patients (53.74%) in conservative and 93 patients (43.05%) in PCI. 84 patients (38.8%) had low energy levels and 44 patients (20.36%) found exercising tiring and painful. Patients with PCI had greater referral issues, cost issues, and low energy levels and found exercise tiring and painful (p< 0.005) than conservatively managed. Conclusions: Referral, Knowledge of CR, access to healthcare resources, and Work Time conflicts are perceived as major barriers to Cardiac Rehabilitation. Additionally, higher Cost issues, Low Energy levels, and fear of exercising were observed more in patients with PCI than in conservatively managed.