Heart failure (HF) is a complex clinical syndrome where the heart is unable to meet the metabolic demands of the body at normal left ventricular filling pressures. HF has a high global disease burden and is associated with significant morbidity and mortality.
Cardiac rehabilitation (CR) is a comprehensive, structured programme that uses a multidisciplinary approach to provide exercise-training, cardiovascular risk management, psychological supports, and health education to patients with heart disease. CR has proven benefits in HF with an improvement in quality of life and functional capacity, and a reduction in hospitalisations and mortality over the long-term.1 CR is recommended for patients recently hospitalized for HF in both the 2022 ACC/AHA (American College of Cardiology/American Heart Association)2 and 2021 ESC (European Society of Cardiology)3 guidelines.
Despite the effectiveness of CR as an intervention in HF, it is significantly underutilised with CR enrolment of less than 10% of eligible patients with HF in the US.4 Patient and physician factors, along with factors relating to the country’s healthcare system, may all contribute to the low rates of enrolment in CR for HF. This study aims to identify the barriers to the use of CR among patients with HF and to identify and compare the degree to which these different factors impact CR enrolment in a European versus United States (US) referral centre. Identification of the barriers to CR utilisation in HF and comparison of these barriers between Europe and the US, may allow us to make meaningful recommendations to improve CR enrolment rates in both centres. We hypothesise that physician under-referral and specific patient barriers significantly influence the low rates of CR enrolment in HF.
