'Just not for me' – contributing factors to nonattendance/noncompletion at phase III cardiac rehabilitation in acute coronary syndrome patients: a qualitative enquiry

Aims and objectives: To explore what reasons do non-attenders and non-completers give for their patterns of participation or non-participation in cardiac rehabilitation programmes and how future uptake could be enhanced.

Background: Cardiac rehabilitation is a cost effective clinical intervention designed for adults with acute coronary syndrome. Despite evidence from meta-analyses demonstrating that cardiac rehabilitation programmes facilitate physical and psychological recovery from acute coronary syndrome, only 20 to 50% of eligible patients attend Phase III outpatient programmes.

Design: A qualitative study using thematic analysis.

Method: Within the context of a larger mixed-method study, acute coronary syndrome patients were recruited between 2012 and 2014 from three hospitals in Scotland. Out of 214 patients who consented to enrol in the main study, a purposive sub-sample of 25 participants was recruited. Semi-structured interviews were conducted and analysed using thematic analysis.

Results: Three major influences of participation were identified: (1) personal factors, (2) programme factors, (3) practical factors. In addition valuable suggestions for future programme modifications were provided. A significant barrier to attending cardiac rehabilitation programmes is that participants perceived themselves to be unsuitable for the programme alongside a lack of knowledge and/or misconceptions regarding cardiac rehabilitation.

Conclusion: The responses of non-attenders and non-completers revealed misconceptions related to programme suitability, the intensity of exercise required and the purpose of a cardiac rehabilitation programme. As long as these misconceptions continue to persist in coronary syndrome patients this will impact upon attendance. The lack of perceived need for cardiac rehabilitation stems from a poor understanding of the programme, especially among non-attenders and non-completers and subsequently an inability to comprehend possible benefits.

Relevance to clinical practice: The knowledge of common misconceptions puts clinical nurses in a better position to identify and pro-actively address these erroneous assumptions in their patients in order to improve participation in cardiac rehabilitation.