A cross-sectional study of cardiac rehabilitation enrollment barriers in patients at risk for suboptimal outcomes from acute coronary syndrome.

Purpose: Cardiac rehabilitation (CR) is an effective treatment to reduce the burden of cardiovascular disease (CVD) but is underutilized. This study characterized CR enrollment barriers and perceived physician endorsement of CR in patient subgroups at increased risk of poor outcomes.

Materials and methods: The association between sociodemographic and clinical characteristics and Cardiac Rehabilitation Barriers Scale (CRBS) item and subscale scores were examined using secondary data analysis of patients with acute coronary syndrome referred to, but not yet enrolled in, a 12-week CR program. Participants rated perceived strength of recommendation to attend CR on 1-5 scale.

Results: The three most endorsed CRBS items were inclement weather, travel, and work responsibilities. Additional barriers (e.g. time constraints, already exercising, family responsibilities) emerged in certain patient subgroups. Perceived strength of physician endorsement was high in the overall sample. After statistical adjustment for confounds, depressed mood was positively associated with logistical (b = 0.05, p = 0.002), and comorbidity-related barriers (b = 0.02, p < 0.001). Female sex (b = 0.62, p = 0.004), higher body mass index (b = 0.05, p = 0.009), and diabetes (b = 1.08, p < 0.001), were associated with logistical barriers.

Conclusions: Patients require individualized support to address CR enrollment barriers. Given their crucial role in supporting patients to access CR, nurses are well-positioned to identify and address CR barriers.