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; Claire Hutchinson; Tania Marin; Joyce S. Ramos; Orathai Suebkinorn; Lemlem G. Gebremichael; Norma B. Bulamu; Wendy Keech; Marie Ludlow; Jeroen Hendriks; Vincent Versace; Robyn A. Clark

doi:10.1177/02692155241236998

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, Claire Hutchinson, Tania Marin, Joyce S. Ramos, Orathai Suebkinorn, Lemlem G. Gebremichael, Norma B. Bulamu, Wendy Keech, Marie Ludlow, Jeroen Hendriks, Vincent Versace, Robyn A. Clark

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Abstract

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.

Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.

Setting: Economically disadvantaged areas in rural Australia.

Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.

Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28).

Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.

Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Original language	English
Pages (from-to)	837-854
Number of pages	18
Journal	Clinical Rehabilitation
Volume	38
Issue number	6
Early online date	17 Apr 2024
DOIs	https://doi.org/10.1177/02692155241236998
Publication status	Published - Jun 2024

Keywords

cardiac rehabilitation
Cardiovascular disease
low socioeconomic status
morbidity and mortality
rural populations

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Final published versionFinal published version, 1.1 MBLicence: CC BY-NC

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Beleigoli, A., Dafny, H. A., Pinero de Plaza, M. A., Hutchinson, C., Marin, T., Ramos, J. S., Suebkinorn, O., Gebremichael, L. G., Bulamu, N. B., Keech, W., Ludlow, M., Hendriks, J., Versace, V., & Clark, R. A. (2024). Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study. Clinical Rehabilitation, 38(6), 837-854. https://doi.org/10.1177/02692155241236998

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title = "Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study",

abstract = "Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.",

keywords = "cardiac rehabilitation, Cardiovascular disease, low socioeconomic status, morbidity and mortality, rural populations",

author = "Alline Beleigoli and Dafny, {Hila Ariela} and {Pinero de Plaza}, {Maria Alejandra} and Claire Hutchinson and Tania Marin and Ramos, {Joyce S.} and Orathai Suebkinorn and Gebremichael, {Lemlem G.} and Bulamu, {Norma B.} and Wendy Keech and Marie Ludlow and Jeroen Hendriks and Vincent Versace and Clark, {Robyn A.}",

year = "2024",

month = jun,

doi = "10.1177/02692155241236998",

language = "English",

volume = "38",

pages = "837--854",

journal = "Clinical Rehabilitation",

issn = "0269-2155",

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Beleigoli, A , Dafny, HA , Pinero de Plaza, MA , Hutchinson, C, Marin, T, Ramos, JS , Suebkinorn, O , Gebremichael, LG , Bulamu, NB, Keech, W, Ludlow, M, Hendriks, J, Versace, V & Clark, RA 2024, 'Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study', Clinical Rehabilitation, vol. 38, no. 6, pp. 837-854. https://doi.org/10.1177/02692155241236998

TY - JOUR

T1 - Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas

T2 - A mixed-methods study

AU - Beleigoli, Alline

AU - Dafny, Hila Ariela

AU - Pinero de Plaza, Maria Alejandra

AU - Hutchinson, Claire

AU - Marin, Tania

AU - Ramos, Joyce S.

AU - Suebkinorn, Orathai

AU - Gebremichael, Lemlem G.

AU - Bulamu, Norma B.

AU - Keech, Wendy

AU - Ludlow, Marie

AU - Hendriks, Jeroen

AU - Versace, Vincent

AU - Clark, Robyn A.

PY - 2024/6

Y1 - 2024/6

N2 - Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

AB - Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

KW - cardiac rehabilitation

KW - Cardiovascular disease

KW - low socioeconomic status

KW - morbidity and mortality

KW - rural populations

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UR - http://purl.org/au-research/grants/NHMRC/1169893

U2 - 10.1177/02692155241236998

DO - 10.1177/02692155241236998

M3 - Article

AN - SCOPUS:85190761571

SN - 0269-2155

VL - 38

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JO - Clinical Rehabilitation

JF - Clinical Rehabilitation

IS - 6

ER -

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study

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Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study

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UN SDGs

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