Enrollment Barriers in Hybrid Cardiac Rehabilitation

Hybrid (i.e., combined center-based with home/community-based) cardiac rehabilitation (HYCR) programs using telehealth have gained interest to improve access to care. The purpose of this analysis is to describe reasons patients were either ineligible to participate or declined enrollment in a trial that involved HYCR. This is a sub-study of the improving ATTENDance to cardiac rehabilitation (iATTEND) trial, currently randomizing subjects to traditional center-based cardiac rehabilitation (CBCR) versus HYCR. This analysis used screening data from the first 23 months of this trial. Data from patients excluded or who declined enrollment was used to review enrollment barriers. Between March 2019 and January 2021, 3,708 patients were referred to cardiac rehabilitation. Of these, 887 (24%) attended a cardiac rehabilitation orientation at a site in the city of Detroit or at one of 2 suburban locations. Among these, 63% (554/887) were ineligible per study criteria, 3% (29/887) lacked access to a smart device, and 14% (128/887) lacked access to exercise equipment. Overall, 23% (205/887) of referred patients declined participation in the trial, and of these, 12% (103/887) declined because they preferred center-based cardiac rehabilitation over HYCR. Among the 157 patients unable to participate due to lack of a smart phone or exercise equipment, the percentage was not significantly different (P = 0.204) between those attending cardiac rehabilitation orientation within Detroit and the suburban locations. Lack of access to a smart device did not represent a meaningful barrier (3%) to participate in a trial involving HYCR. Access to exercise equipment represented a potential barrier (14%).