Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.
Alline Beleigoli, Hila Ariela Dafny, Maria Alejandra Pinero de Plaza and 11 others
PMID 38631370WHAT IT FOUND
Only 11.2% of eligible rural separations completed cardiac rehabilitation.
Completion was associated with lower risk of death or cardiovascular admission, while commencing without completing was not associated with lower risk.
Key findings
01Of 16,159 eligible separations, 7,159 were referred, 2,394 commenced, and 1,806 completed; the completion rate among eligible separations was 11.2%.
02After adjustment, completing cardiac rehabilitation was associated with lower risk of death or cardiovascular admission (HR 0.65; 95% CI 0.57 to 0.74; p<0.001), while commencing without completing was not associated with lower risk (HR 0.94; 95% CI 0.78 to 1.13; p=0.478).
03The qualitative study found five barrier themes: logistic issues, social support, transition of care, programme delivery, and care integration; telehealth was associated with lower chance of non-completion, but participants reported needing personalised mental health support, tailored exercise training, and peer support.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The quantitative part was observational, so it shows associations rather than proof that cardiac rehabilitation caused the lower risk. Even with weighting and adjustment, selection bias and residual confounding may remain. The primary outcome was utilisation, not the clinical composite outcome; the composite finding was secondary. Dementia patients (n=135) were excluded because the weighted model did not balance prior dementia across groups. The qualitative sample was small and likely underrepresented women, people with English as a second language, and Aboriginal and Torres Strait Islander peoples. Completion and non-completion reasons were recorded by clinicians using a close-ended list, so other reasons may be missing.
Declared interests
Funding was provided by the National Health and Medical Research Council and the Flinders Foundation Health Seeding Grant. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not read the lower risk associated with completion as proof that cardiac rehabilitation caused the benefit. The study was observational, and the primary outcome was cardiac rehabilitation utilisation, not the composite death or admission outcome.