Patient engagement with cardiac rehabilitation: a systematic review and meta-synthesise of qualitative studies

Matthew Rumble, Linda Ross, Jackie Miles, David Pontin

Research output: Contribution to journalConference or Meeting Abstractpeer-review


Background: Patient engagement with Cardiac Rehabilitation (CR) services is still below optimal levels (NACR 2019). CR programmes has been shown to be effective in reducing patient cardiac mortality (Anderson 2017).

Aim: What influences patients’ decision to engage with CR services.

Methods: A systematic search was conducted using search terms (e.g. cardiac rehabilitation, attendance, adherence etc.), within several databases (e.g. Medline (OVID), Embase (OVID), CINAHL Plus, and ProQuest.) using the time frame 2013-2021. The search identified 32 qualitative papers suitable for the research aim.

A meta-analysis was performed using thematic synthesis(Thomas and Harden 2008). The analytical themes were ordered within a nested socio-ecological model; intrapersonal, interpersonal, logistical, and service level factors.

Results: The review identified 21 analytical themes which influence patient engagement.

Intrapersonal factors; Patients often described misconceptions of CR services, CVD, and exercise. Not understanding the true purpose of CR and the management of their disease. For example patients expressed a “fear of exercise” and avoidance of physical activity. Physical impairments were often described as a barrier to engagement. Interpersonal factors: Family support was described as a facilitator to engagement. Patients who lived alone described difficulty in maintaining motivation to engage. Support of peers in CR classes increased camaraderie and a sense of belonging (“we are all in this together”). Work commitments appeared to be a barrier due to CR scheduled sessions running within working hours. Logistical: Patients described a lack of transportation as a barrier to CR . Service level factors: Centre-based sessions provided a supportive environment to help negate patients’ fear of physical activity. A lack of timely and personalised communication between CR services and patients was seen as a barrier to enrolment.

Conclusion: Misconceptions of patient perceived eligibility and communication of the benefits of CR can influence patient’s decision to engage. Furthermore, engagement may be improved via offering patients adequate communication and greater flexibility over their rehabilitation journey.
Original languageEnglish
Pages (from-to)A12-A13
Issue numberSuppl 4
Publication statusPublished - 21 Nov 2022


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