Cardiac Rehabilitation Enrolment, Adherence, and Barriers in Semi-Urban Indian Populations: A Mixed-Methods Twelve-Month Cohort with Structured Barrier Assessment

Dr. Rajesh Bhatia, R. Jayapriya, Dr. Arun Kumar

Cardiac Rehabilitation; Enrolment; Adherence; Barriers; Secondary Prevention; Semi-Urban India; Mixed Methods.

Cardiac rehabilitation is a Class I-recommended intervention after acute coronary syndrome and coronary revascularisation, yet enrolment and completion rates remain low in many South Asian settings. We followed 358 patients eligible for cardiac rehabilitation at a semi-urban tertiary cardiac centre over 12 months, capturing referral, acceptance, attendance, completion, and barriers through quantitative tracking and a structured patient interview at three months. Of 358 patients offered referral, 236 (65.9%) accepted, 147 (41.1%) attended at least one session, and 85 (23.7%) completed all 36 sessions. Acceptance and completion declined steeply with age. The most frequently reported barriers were travel distance and transport cost (40% of patients surveyed), loss of daily wages or work demands (33%), and family caregiving responsibilities (25%). At 12 months, cardiovascular readmission occurred in 9.4% of programme completers compared with 19.4% of partial attenders and 30.3% of patients who did not enrol (log-rank p less than 0.001). These findings argue for a fundamental redesign of cardiac rehabilitation delivery in semi-urban Indian settings toward hybrid and home-based models, integrated transport support, and flexible scheduling rather than further investment in the conventional centre-based template.

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