Barriers to Cardiac Rehabilitation Participation Faced by Patients of Lower Socioeconomic Status

Purpose: Individuals with lower socioeconomic status (SES) are less likely to engage in cardiac rehabilitation (CR) following a major cardiac event. Identifying barriers to attending CR is crucial for facilitating recovery for this vulnerable population. Methods: Data are from a randomized controlled trial on improving CR attendance for individuals with lower SES (N = 192; 35% female). Of these, 103 (40% female) were randomly assigned to a case management arm and included in the present analysis. Participants were recruited at or shortly after hospitalization for a CR-qualifying cardiac event and were asked about 1) their primary post-discharge concern (Concerns Assessment) and 2) eight potential barriers to CR attendance/secondary prevention (Barriers Assessment; medical, transportation, employment, financial, housing, psychosocial, childcare, legal). Concerns were sorted into these categories, and the frequency of each was calculated and ranked. Results: Sixty-eight participants (66%) completed the Concerns Assessment, and 96 (93%) completed the Barriers Assessment. Health-related issues were the most common primary post-hospitalization concern (57%), followed by no concerns (16%). Financial (70%), employment (48%), and transportation (47%) issues were the three most cited barriers. Conclusions: Participants most often rated their health as their primary concern at hospitalization, but non-medical needs were more often reported as barriers. The obstacles commonly identified in the present study are often not addressed during hospital admission. Hospitalization is a critical time for emergent treatment and is where support for on-going care should begin. Addressing these barriers before discharge is an important step toward improving secondary prevention.