Introduction

Cardiac rehabilitation (CR) is an evidence-based intervention designed to improve the quality of life, functional capacity, and prognosis of patients with heart failure (HF). Despite its proven benefits, the utilization of CR programs remains suboptimal globally. Understanding the knowledge, attitudes, and practices (KAP) of both patients with HF and cardiology healthcare providers (HCPs) is critical for improving participation rates and program effectiveness.

Knowledge of Cardiac Rehabilitation

1. Patients with Heart Failure:

   • Many HF patients lack awareness of CR and its benefits. Misconceptions, such as believing CR is only for patients recovering from heart attacks, are common.
   • Studies show that patients often underestimate the role of structured exercise and lifestyle modification in improving heart function and reducing symptoms.

2. Cardiology Healthcare Providers:

   • Most HCPs understand the benefits of CR, including reduced hospital readmissions and improved survival.
   • However, there are knowledge gaps regarding specific CR protocols, especially in relation to HF patients with preserved ejection fraction (HFpEF) or other comorbidities.

Attitudes Toward Cardiac Rehabilitation

1. Patients with Heart Failure:

   • Positive attitudes are linked to improved awareness of CR benefits, social support, and encouragement from HCPs.
   • Barriers include fear of physical activity, lack of confidence in managing their condition, and concerns about costs or transportation.
   • Cultural and psychosocial factors, such as stigma and limited family support, can also influence attitudes.

2. Cardiology Healthcare Providers:

   • Most providers have a favorable attitude toward CR and recognize its importance in HF management.
   • Challenges include limited time to discuss CR with patients, uncertainty about referral criteria, and perceived patient noncompliance.

Practice of Cardiac Rehabilitation

1. Patient Participation:

   • Only a small percentage of eligible HF patients enroll in CR programs.
   • Factors contributing to low participation include logistical challenges, such as distance to CR centers, and competing priorities, such as work or caregiving responsibilities.
   • Adherence to CR programs tends to decline over time, with common reasons being lack of perceived benefit and difficulty maintaining lifestyle changes.

2. Healthcare Provider Referral Practices:

   • Referral rates for HF patients remain low compared to other cardiac conditions like myocardial infarction or coronary artery bypass surgery.
   • Electronic referral systems have been shown to increase CR referrals but are not widely implemented.
   • Some providers prioritize other treatments over CR due to a lack of institutional resources or program availability.

Strategies to Improve KAP in Cardiac Rehabilitation

1. Patient Education:

   • Conducting structured education sessions to explain the role of CR in HF management.
   • Utilizing visual aids, brochures, and digital tools to simplify complex information.
   • Engaging family members in educational efforts to enhance support and motivation.

2. Healthcare Provider Training:

   • Organizing workshops and continuing medical education (CME) programs to address knowledge gaps in CR.
   • Encouraging multidisciplinary collaboration between cardiologists, physiotherapists, and CR specialists.

3. Enhancing Access and Adherence:

   • Developing home-based and tele-rehabilitation programs to overcome logistical barriers.
   • Offering financial assistance or insurance coverage to make CR more accessible to underserved populations.
   • Implementing follow-up strategies, such as regular check-ins and motivational counseling, to sustain adherence.

Conclusion

The knowledge, attitudes, and practices of patients with heart failure and cardiology healthcare providers significantly influence the success of cardiac rehabilitation programs. Addressing barriers at both patient and provider levels through education, resource optimization, and system-wide changes can improve CR participation and outcomes. By prioritizing CR as a cornerstone of HF management, we can enhance patient quality of life and reduce the burden of heart failure globally.