Laura Correia

Background Cardiac rehabilitation (CR) provides proven benefits, yet only 50% of eligible individuals participate, with females and ethnic minority groups being particularly underrepresented. This study aimed to explore healthcare professionals’ (HCPs) views on factors influencing referral and attendance to phase III CR services in the United Kingdom (UK), with the purpose of identifying evidence-based recommendations and strategies to enhance access and participation. Methods Thirty-eight HCPs involved in the cardiac care or rehabilitation of patients with coronary heart disease (CHD) participated in a three-round Delphi study. Participants were asked about staff competencies, CR core components, referral criteria, referral pathways, and the impact of sex and ethnicity on referral and attendance. Results 108 statements were proposed by the participants. Consensus was achieved on 53 statements covering 10 key aspects of CR. HCPs identified significant disparities in referral practices and attendance, attributing these to HCP knowledge gaps, lack of streamlined referral pathways, and non-inclusive referral processes. They emphasised the need for educational initiatives within general practitioner surgeries and the development of direct referral pathways to improve CR access. Additionally, HCPs highlighted the importance of educating ward staff on inclusive practices and cultural sensitivity to improve referrals, particularly for females and ethnic minority groups. Conclusions The study highlights disparities in CR referral and attendance, particularly by sex and ethnicity. It provides evidence-based recommendations to ensure equitable access to CR services. Future interventions should focus on tailored education for HCPs and streamlined, direct referral pathways to ensure inclusive access for diverse populations in the UK.

Background Cardiovascular rehabilitation (CR) is a crucial element in the management of coronary heart disease (CHD). However, only 52% of those eligible for CR participate in it, with lower engagement among females and minority ethnic groups. Despite reported barriers to participation, healthcare professionals’ (HCPs) perspectives on referral and attendance remains unexplored. Aim To explore the perspectives of HCPs on factors influencing referral and attendance to CR services in the UK. Methods A three-round Delphi study (May to September 2023) involved 38 HCPs recruited via snowball sampling. In Round One, 12 open-ended questions enquired about participants’ views on staff competencies, core components of CR, referral criteria, referral pathways, and the associations between sex and ethnicity related to referral and attendance. Content analysis informed a structured five-point Likert scale questionnaire used in Round Two. Consensus was defined a priori as ≥ 70% agreement among the participants. In Round Three, participants were asked to retake the questionnaire after receiving feedback for individual and group responses. Results Consensus was achieved on 53 of the 108 statements, covering 10 key aspects of CR. HCPs acknowledged significant disparities in UK CR programmes, attributing these to knowledge gaps. HCPs emphasised the need for educational initiatives within general practitioner (GP) surgeries and direct referral pathways as effective strategies for enhancing sex-specific referrals to phase III CR. Furthermore, HCPs suggested education for hospital ward staff on inclusion and cultural training, alongside building relationships with local communities, to improve ethnic-specific referrals to CR (table 1). Conclusion This study highlights HCPs perspectives on referral and attendance to CR programmes in the UK, focusing on sex and ethnicity. HCPs emphasised the urgent need for initiatives to enhance clinicians’ knowledge and ensure inclusivity in CR services. Future research should build on these findings to promote equitable access to CR for diverse UK populations.