Supervised exercise barriers and readmission in patients with heart failure in a low-resource setting Barriers to Cardiac Rehabilitation in patients with heart failure

Abstract Background: This study assessed cardiac rehabilitation (CR) barriers in heart failure (HF) patients for the first time, use of formal exercise supervision, and readmissions. Methods: This was a prospective study of HF in-patients at a private hospital. The CR Barriers Scale (CRBS), and International Physical Activity Questionnaire were administered. Participants were called 30 and 90-days to ascertain formal exercise supervision and readmissions. Results: Of 95 participants, 85 (89.5%) were retained at the 30-day call, and 86 (90.5%) at 90; 2 died. The mean total CRBS score was 2.3±.6.5, with highest item scores for lack of energy, already exercising, lack of awareness, distance and exercise pain/fatigue. Only 1 participant enrolled in CR, but close to half had engaged an exercise professional (n=48, 56.5% and n=45, 52.3%) at both follow-ups. 25.8% of patients were readmitted at 30 days and 25.5% at 90 days. Participants who had professional exercise supervision within 30 days had significantly fewer readmissions (n​​=7, 14.6%) compared with patients who did not (n=13, 35.1%; p=0.03). Conclusions: CR barriers are high in HF patients. Despite some accessing professional exercise training, most were insufficiently active. Systematic CR referral and coverage advocacy could mitigate this poor self-management, and ultimately the high readmissions.