Beliefs, Recommendation, and Influencing Factors of Cardiovascular Professionals on Cardiac Rehabilitation in China: A Cross-Sectional Study

Objective: This study aims to understand the values, attitudes and beliefs of cardiovascular healthcare staff in China, along with the current landscape and influencing factors regarding the recommendation of cardiac rehabilitation (CR). Design and method: A nationwide cross-sectional study of 1096 cardiovascular doctors, nurses and rehabilitation therapists was included by convenience sampling from December 19, 2023 to January 9, 2024 through an online survey platform. Questions on personal information, knowledge on CR, recommendation, and the Chinese version of the Recommending Cardiac Rehabilitation(ReCaRe) Scale were administered. Descriptive, univariable analyses and multivariable logistic regressions were conducted. Results: A total of 1096 valid questionnaires were collected. Among the surveyed individuals, 626 had recommended CR to patients (56.9%). The ReCaRe scale's total score was 58.7±6.4, with scores in three dimensions: perceived severity and susceptibility 28.9±4.2 (average 4.0±0.6), perceived service accessibility 8.1±2.9 (average 2.7±1.0), and perceived benefit and barriers 22.7±2.4 (average 3.8±0.4). The results show that healthcare professionals’ perceive severity and susceptibility was the primary decision-making factor in recommending cardiac rehabilitation, followed by perceived benefits and barriers, while perceived service accessibility was the least impact factor. The influencing factors for medical professionals to recommend CR include: age(age>40 vs age<=40: OR=1.75, 95%CI=1.12-2.71, P=0.013), professional title(specialist or higher vs resident: OR=2.44, 95%CI=1.69-3.54, P<0.001), work type(doctor vs nurse: OR=2.11, 95%CI=1.48-3.00, P<0.001; rehabilitation therapist vs nurse: OR=2.28, 95%CI=0.47-11.04, P=0.308), hospital type(general hospital vs community healthcare center: OR=2.38, 95%CI=1.36-4.14, P<0.002; specialized hospital vs community healthcare center: OR=7.21, 95%CI=1.03-50.32, P=0.046), department(cardiac department vs general medicine department: OR=9.22, 95%CI=1.44-58.87, P=0.019; rehabilitation department vs general medicine department: OR=15.92, 95%CI=1.94-130.27, P=0.010), resources available of cardiac rehabilitation(yes vs no: OR=3.78, 95%CI=2.57-5.54, P<0.001), and knowledge of CR (knowing a little vs unfamiliar: OR=3.57, 95%CI=2.52-5.05, P<0.001; familiar vs unfamiliar: OR=18.26, 95%CI=11.26-29.61, P<0.001). Unexpectedly, ReCaRe score had no effect on medical staff's recommendation of CR (all P>0.05). Conclusions: Healthcare professionals’ perceive severity and susceptibility was their primary decision-making factor in recommending CR. The influencing factors for their recommendation of CR include: age, professional title, work type, hospital type, department, resources available of cardiac rehabilitation and knowledge of cardiac rehabilitation.