Cardiac Rehabilitation: Are People With Stroke or Transient Ischaemic Attack Being Included? A Cross-Sectional Survey

Background: Cardiac rehabilitation (CR) may be an effective secondary prevention program for people with stroke or transient ischaemic attack (TIA). The aims of this study were to determine whether people with stroke or TIA were attending CR in Australia and if there were any barriers to attendance.

Methods: An invitation to participate in an online survey was distributed between January and April 2018, via email, to 411 phase 2 CR coordinators located across Australia. These coordinators were identified through a publicly available directory. The survey contained questions on the demographics of CR programs and attendance of people with stroke or TIA. A Likert scale was used to investigate perceived barriers to CR for people with stroke or TIA. Descriptive statistics were completed for all survey responses except those from open text questions, which were analysed via an inductive qualitative approach.

Results: In total, 149 CR coordinators responded who managed a total of 154 programs. The programs were primarily located in regional (40%) or metropolitan (31%) areas. Nearly 50% of programs were based in a public hospital-based gym/outpatient centre. Over 90% (n = 97/104) of coordinators reported that people with a primary diagnosis of stroke or TIA accounted for less than 2% of their patient population. Despite this, 52% of coordinators thought CR was an appropriate form of secondary prevention for people with stroke or TIA. The largest perceived barriers to attendance were safety (79%, n = 80/101), limited staff to patient ratio (76%, n = 77/101), integration difficulties (68%. n = 69/101) and a lack of referrals (66%, n = 67/101).

Conclusion: Few people with a primary diagnosis of stroke or TIA attend CR in Australia, despite over half of CR coordinators believing that CR is appropriate for this group. Cardiac rehabilitation may be particularly suitable for people with mild-stroke or TIA. However, further research is required.