Factors impacting uptake of cardiac rehabilitation in people with chronic heart failure: targets for interventions

Introduction: Participation in exercise-based cardiac rehabilitation (ExCR) can improve quality of life and reduced hospital readmission, but uptake is low in people with chronic heart failure (CHF). This may be impacted by frailty and other comorbidities.

Aim: Explore the impact of frailty and other patient related factors on acceptance of referral to CR service following an admission to hospital with an episode of acute decompensated CHF (ADHF) in order to identify targets for behaviour change interventions.

Methods:

1. Systematic review exploring the benefits of physical activity interventions in people with long term cardiac conditions and frailty.

2. Audits addressing the eligibility and access of inpatients with ADHF to referral to CR service.

3. Observational study investigating the relationship between frailty and referral to CR service.

4. Qualitative interviews, focus group and survey identifying targets for interventions to increase acceptance of referral to CR service by people with CHF.

Results: Frailty impacts eligibility for ExCR but probably not acceptance rate for referral to a programme, if eligible. Exercise based interventions can improve physical function in people with CHF and frailty. Most eligible inpatients are offered referral to ExCR by the heart failure nursing service (HFNS). Qualitative data showed people with de novo CHF have different reasons (need for information, hope for recovery) for engagement with ExCR compared with those with established CHF (learning to live with limitations).

Conclusion Work should focus on co-designing interventions with stakeholders including those newly diagnosed and people with established CHF, as they may need different approaches. The HFNS may be an effective way of providing novel face to face interventions at different point in the patient journey. Those patients currently ineligible for ExCR, may need adapted programmes or novel interventions.