References
Exploring ways to improve completion of cardiac rehabilitation in areas of high deprivation
Abstract
Background:
Cardiac rehabilitation (CR) completion rates are higher in patients living in areas of low deprivation than in those living in areas of high deprivation, widening the health inequality gap.
Aim:
A service evaluation was undertaken in the Coventry CR Service to explore the barriers to and facilitators of service completion among patients living in high-deprivation areas, to understand the most important factors to consider when undertaking service improvements.
Design:
A process map was completed of the current service. Patients’ postcodes were matched with the Index of Multiple Deprivation and used to categorise a high-deprivation area. Purposive recruitment of patients took place during CR clinic appointments. Service users were then interviewed using a semi-structured questionnaire on discharge from the service, and enrolment was stopped at data saturation. Thematic analysis was used. The service was evaluated using the World Health Organization Building Blocks Framework and themes reviewed in terms of service delivery, health workforce, information, technology, and financing.
Participants:
Twelve patients who took part in CR between May and August 2022 were interviewed. Facilitators of completion included: personalised CR programmes, work flexibility, social aspects, relating to others, enjoyment, staff and patient education. Barriers included: family commitments, work, not relating to others, parking, the gym environment and poor communication.
Conclusion:
The two main ways the service could be improved to increase completion is to enhance programme flexibility and patient education in the home-based programme. Investment in technology may mean that facilitators of the gym-based programme, such as monitoring, two-way communication and exercise progression, can be replicated at home.
In the UK, one-quarter of all deaths are caused by heart and circulatory diseases, and heart attacks account for more than 100 000 hospital admissions a year (British Heart Foundation, 2025). It has been estimated that 80% of premature heart attacks are preventable with correct risk-factor modification advice (Waterall, 2018). However, individuals living in highly deprived areas of England are almost four times as likely to suffer early death from coronary heart disease as those living in less deprived areas (Lomas and Williams, 2019).
Cardiac rehabilitation (CR) is a combination of activities designed to improve health behaviours, reduce risk factors for coronary heart disease and help patients recommence life in their communities (British Association for Cardiovascular Prevention and Rehabilitation (BACPR), 2023). CR is cost effective and has been shown to lower risk of all-cause mortality, cardiovascular mortality and cardiovascular risk factors at 1 year after a myocardial infarction (MI) (Shields et al, 2018; Eijsvogels et al, 2020; Sjölin et al, 2020; Dibben et al, 2021; 2023). The UK National Institute for Health and Care Excellence (2020) guidance recommends that all patients who have had an MI should be offered CR and encouraged to attend. CR also increases functional capacity and has been linked to a reduction in hospitalisations for patients with heart failure and following heart valve surgery, but is underused in both these patient groups (Patel et al, 2019; Abraham et al, 2021; Bozkurt et al, 2021).
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