Determinants of Progression from Phase III to IV Cardiac Rehab
Research type
Research Study
Full title
A Multi-centred Exploratory Study Investigating the Determinants of Progression from Phase III to Phase IV Cardiac Rehabilitation in Underrepresented Populations
IRAS ID
322092
Contact name
Stefan Birkett
Contact email
Sponsor organisation
Manchester Metropolitan University
Duration of Study in the UK
1 years, 3 months, 1 days
Research summary
In the United Kingdom (UK) >2.3 million people are living with coronary heart disease (CHD) (1). Cardiac rehabilitation (CR) is a core component of secondary prevention that reduces hospitalisations, cardiovascular mortality and improves quality of life (2). Traditionally, CR has four phases: Phase I (in-hospital), Phase II (early outpatient), Phase III (early CR typically 8-11 weeks in duration) and Phase IV, the long-term maintenance programme which aims to further build on the success of Phase III (3). As longer-term CR programmes (beyond 11 weeks) are associated with reductions in mortality, greater gains in fitness and improvement in risk factors (4-6), it is important that patients are encouraged to continue to take part in CR for as long as possible. Despite the associated benefits of CR, pre-Covid-19, only 50% of those eligible in the UK accessed Phase III (7) with this percentage further decreasing during the pandemic to 36%. A major concern was that there was a further reduction of 11% and 6% in ethnic minorities and female participation, two groups already significantly underrepresented in CR (7). Consequently, the most recent National Audit of Cardiac Rehabilitation (NACR) report (2021) stated that the development and implementation of strategies to halt the widening gap is a key priority. Data regarding uptake for long-term phase IV CR are limited (8). International data showed that of those patients who attended early CR only 5 to 30% transferred to long-term CR, demonstrating poor transition (9,10). However, to date, barriers to Phase IV in underrepresented groups have not been reported in the UK. Given the declining participation in CR, it is paramount to investigate uptake to Phase IV in the UK and understand the factors that influence initiation or non-initiation in underrepresented groups.
Therefore, the aim of this study is to investigate factors that influence progression from Phase III to Phase IV CR in underrepresented groups (females and ethnic minorities). We will determine these factors from the questionnaires completed by the study participants, focusing on the reasons why the participant did or did not take up Phase IV CR following completion of Phase III. We will also conduct semi-structured interviews which will determine how participants’ identify success in Phase III CR, the importance of social support during CR, and the importance of CR for individual health and wellbeing.
REC name
West of Scotland REC 5
REC reference
23/WS/0155
Date of REC Opinion
7 Nov 2023
REC opinion
Further Information Favourable Opinion