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. 2024 Jun;38(6):837-854.
doi: 10.1177/02692155241236998. Epub 2024 Apr 17.

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study

Alline Beleigoli  1 , Hila Ariela Dafny  1 , Maria Alejandra Pinero de Plaza  1 , Claire Hutchinson  1 , Tania Marin  1 , Joyce S Ramos  1 , Orathai Suebkinorn  1 , Lemlem G Gebremichael  1 , Norma B Bulamu  2 , Wendy Keech  3 , Marie Ludlow  4 , Jeroen Hendriks  1 , Vincent Versace  5 , Robyn A Clark  1
Affiliations

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study

Alline Beleigoli et al. Clin Rehabil. 2024 Jun.

Abstract

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.

Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.

Setting: Economically disadvantaged areas in rural Australia.

Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.

Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28).

Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.

Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Keywords: Cardiovascular disease; cardiac rehabilitation; low socioeconomic status; morbidity and mortality; rural populations.

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Figures

Figure 1.
Figure 1.
Mixed-methods study diagram.
Figure 2.
Figure 2.
Quantitative study flow diagram.
Figure 3.
Figure 3.
Adjusted all-cause mortality/cardiovascular readmission rates within 12 months after the index hospitalisation.
See this image and copyright information in PMC

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