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barriers, cardiac rehabilitation, partcipation rates



  1. Fernandez, Ritin S. PhD(c), MN (Critical Care), RN
  2. Davidson, Patricia PhD, RN
  3. Griffiths, Rhonda AM DrPH, RN


Background: Coronary heart disease remains the leading cardiovascular cause of mortality and morbidity globally. Implementing evidence-based guidelines after a coronary event is vital to prevent recurrence of an acute episode. However, various barriers to guideline implementation have been identified.


Objective: This article presents the perspective of cardiac rehabilitation (CR) coordinators regarding patient-related barriers to implementing the evidence-based guidelines after an acute cardiac event.


Methods: Twenty CR coordinators from 4 geographic regions of New South Wales, Australia, participated in the study. A semistructured interview using open-ended questions was used to obtain the CR coordinator's perspectives of the patient-related barriers to guideline implementation. Interviews were transcribed, and content analysis was undertaken.


Findings: The most frequently identified patient-related barriers were (a) coming to terms with a diagnosis of heart disease, (b) challenges in changing behavior, (c) having heart disease is costly, and (d) other personal barriers.


Conclusions: Despite CR coordinators having positive attitudes toward implementing evidence-based guidelines, several patient-related barriers were identified that obstructed the implementation process. The findings have important implications for nursing practice in terms of directing efforts at increasing participation in CR and engaging commitment of the patient to behavior change. Changes to health service policies that address identified barriers could further facilitate the provision of evidence-based care to patients with coronary heart disease.