Patients With Heart Failure Describe Benefits, Facilitators And Barriers To Home And Community Based Models Of Cardiac Rehabilitation-What Makes Me Move

Introduction Only 2.7% of eligible patients with heart failure (HF) attend cardiac rehabilitation (CR) despite its benefits. Home and community based models of CR have been developed in an effort to overcome known attendance barriers for HF patients such as lack of access to local CR programs, cost, lack of provider referral, time conflicts, and physical limitations to exercise. However, there has yet to be a systematic review of the HF patient experiences with home and community based models of CR. This qualitative data can provide critical insight as to what makes a physical activity intervention accessible and appealing to patients with HF in order to guide future intervention design and implementation and reduce disparities in access to CR. Aim To determine experiences with home and community based models of CR in patients with HF. Methods We systematically searched PubMed, CINAHL, Web of Science and PsychINFO for studies that included perspectives of patients with HF participating in a home or community based model of CR published between 2009 and Jan 2022. We then conducted a thematic analysis of the results section of each included study. Results 12 studies were included, representing the perspectives of 188 individuals who participated or supported patient participation in a home or community based model of CR. Exercises included: aquatic, exergaming, chair-based exercise, walking, tai chi, aerobics and yoga. Three programs were center-based, and the remaining 9 were home-based. Communication methods of home-based programs included intermittent or scheduled phone calls, home visits, or hospital visits. Patient perspectives comprised three central themes: (1) Exercise Benefits; (2) Exercise Facilitators; and (3) Barriers that altered or prevented participation. Participants in all 12 studies reported an improvement in self-efficacy and lifestyle changes as well as in physical health. Peer and family support was the largest facilitator, followed by feeling safe and supported during exercise, and convenient access to the CR program. Seven out of 12 study participants described fearful preconception about exercising as a barrier. Conclusions All home and community based models of CR were found to be physically, psychologically, and/or socially beneficial to patients with HF. Patients described facilitators and barriers that were influential in the decision to initiate and continue exercise. Home and community based models are an innovation to disparities in access to CR; these results can aid in the design of future models. Only 2.7% of eligible patients with heart failure (HF) attend cardiac rehabilitation (CR) despite its benefits. Home and community based models of CR have been developed in an effort to overcome known attendance barriers for HF patients such as lack of access to local CR programs, cost, lack of provider referral, time conflicts, and physical limitations to exercise. However, there has yet to be a systematic review of the HF patient experiences with home and community based models of CR. This qualitative data can provide critical insight as to what makes a physical activity intervention accessible and appealing to patients with HF in order to guide future intervention design and implementation and reduce disparities in access to CR. To determine experiences with home and community based models of CR in patients with HF. We systematically searched PubMed, CINAHL, Web of Science and PsychINFO for studies that included perspectives of patients with HF participating in a home or community based model of CR published between 2009 and Jan 2022. We then conducted a thematic analysis of the results section of each included study. 12 studies were included, representing the perspectives of 188 individuals who participated or supported patient participation in a home or community based model of CR. Exercises included: aquatic, exergaming, chair-based exercise, walking, tai chi, aerobics and yoga. Three programs were center-based, and the remaining 9 were home-based. Communication methods of home-based programs included intermittent or scheduled phone calls, home visits, or hospital visits. Patient perspectives comprised three central themes: (1) Exercise Benefits; (2) Exercise Facilitators; and (3) Barriers that altered or prevented participation. Participants in all 12 studies reported an improvement in self-efficacy and lifestyle changes as well as in physical health. Peer and family support was the largest facilitator, followed by feeling safe and supported during exercise, and convenient access to the CR program. Seven out of 12 study participants described fearful preconception about exercising as a barrier. All home and community based models of CR were found to be physically, psychologically, and/or socially beneficial to patients with HF. Patients described facilitators and barriers that were influential in the decision to initiate and continue exercise. Home and community based models are an innovation to disparities in access to CR; these results can aid in the design of future models.