Barriers to cardiac rehabilitation and their association with hospital readmission in patients with heart failure

Abstract

Background: High rehospitalization rates and limited access to cardiac rehabilitation characterize heart failure in South America. This study highlights the significant barriers faced by patients, including lack of energy, awareness, and accessibility. Despite these challenges, professional exercise supervision has reduced readmission rates by more than 50%, underscoring its importance. ■ Barriers to rehabilitation: high inactivity rates (88.4%) and significant barriers, such as fatigue and lack of awareness, hinder recovery. ■ Professional supervision: only 1% of patients were enrolled in formal cardiac rehabilitation; however, those who received professional supervision experienced lower readmission rates (14.6% versus 35.1%). ■ Systematic gaps: addressing systemic gaps, such as coverage and referral to rehabilitation programs, is critical for improving patient outcomes and reducing rehospitalization rates.

Objective: This study assessed the barriers to cardiac rehabilitation in inpatients with heart failure, the use of formal exercise supervision, and its relationship to readmissions.

Methods: This study was a prospective, observational design. The Cardiac Rehabilitation Barriers Scale, the Readiness Scale focusing on physical activity, and the International Physical Activity Questionnaire were administered before hospital discharge. Participants were followed up via telephone at 30- and 90-days post-discharge, during which the International Physical Activity Questionnaire was readministered, and formal exercise supervision and readmission rates were assessed.

Results: Of the 95 patients who provided consent, 88.4% were inactive. A total of 85 (89.5%) were retained at the 30-day follow-up, and 86 (90.5%) patients at the 90-day follow-up; 2 patients died. The mean total Cardiac Rehabilitation Barriers Scale score was 2.3±6.5 (out of 5), with the highest item scores for lack of energy, prior exercise, lack of awareness, distance, and exercise-related pain/fatigue. Only one participant was enrolled in cardiac rehabilitation. Nearly half had engaged in professional exercise (n=48, 56.5% at 30 days and n=45, 52.3% at 90 days) at both follow-ups. At 30 days, 25.8% of the patients were readmitted, and 25.5% were readmitted at 90 days. Participants who received professional exercise supervision within 30 days had significantly fewer readmissions (n=7, 14.6%) than those who did not (n=13, 35.1%; p=0.03).

Conclusion: Barriers to cardiac rehabilitation are high among patients with heart failure. Despite access to professional exercise training, most participants remain insufficiently active. Systematic referral for cardiac rehabilitation and advocacy for coverage could mitigate poor self-management and, ultimately, reduce high readmission rates.

Registry of clinical trials: NCT03385837.

Graphical abstract