People with coronary heart disease are at an increased risk of experiencing adverse cardiac events such as heart attack. Cardiac rehabilitation programmes aid recovery from a cardiac event or surgery and reduce the likelihood of further illness. Cardiac rehabilitation programmes vary, but usually include one or more of the following: exercise, education, and psychological counselling/support. Despite the benefits of cardiac rehabilitation, not everyone agrees to participate and, of those who do, many people do not adhere to the programme recommended. This Cochrane review evaluated trials of ways to increase the uptake of cardiac rehabilitation and to improve adherence amongst those who choose to participate.
We searched a wide variety of databases and found ten randomised control trials that were suitable for inclusion (three trials of interventions to improve uptake, and seven of interventions to improve adherence). The studies evaluated a variety of techniques to improve uptake or adherence and in many studies a combination of strategies was employed. The quality of studies was generally low. All three interventions targeting uptake of cardiac rehabilitation were effective. Two of seven studies intended to increase adherence to exercise as part of cardiac rehabilitation had a significant effect (one of which was of poor quality). Very few studies reported the effects of the interventions on clinical outcomes or health related quality of life and none provided information about costs or resource implications.
The differences between the strategies used in the studies we identified mean that it is difficult to make recommendations at this stage. Interventions targeting patient identified barriers may increase the likelihood of success. Further high quality research is needed, particularly in under-represented groups such as women, ethnic minorities, older patients, heart failure patients, and those with co-morbidities.