Motivational Interviewing and Cognitive Behavioural Therapy in the Auckland Cardiac Rehabilitation Programme: A Propensity Score-Matched Study

AIM: Suboptimal enrolment and engagement in cardiac rehabilitation remains a persistent issue worldwide. This study evaluated the impact of a nurse-specialist-delivered motivational interviewing (MI) and cognitive behavioural therapy (CBT) intervention on cardiac rehabilitation enrolment, attendance, all-cause mortality, and readmission in Auckland's 2022 cardiac rehabilitation programme compared with a propensity score-matched historical cohort. METHOD: This study included all patients (n=797) referred to Auckland's outpatient cardiac rehabilitation programme in 2022. Outcomes were compared with a retrospective cohort of 3,331 patients enrolled in the Auckland cardiac rehabilitation programme (2016-2020), from which a propensity score-matched historical cohort was created (n=779 per group, 97.7% retention). Data were extracted from the Auckland health district medical database. Primary outcomes included cardiac rehabilitation enrolment and attendance, all-cause mortality, and readmissions (1.5-year average follow-up). Analysis included comparisons of proportions, inferential statistics, Cox proportional hazards, and logistic regression. RESULTS: Cardiac rehabilitation enrolment in 2022 was 54.4%, with 40.2% of patients attending at least one lifestyle session (mean 4.0±2.7 sessions) and 32.8% attending at least one exercise session (mean 10.2±6.9 sessions). The intervention did not improve enrolment, attendance, mortality, or readmission rates. Patients in 2022 attended fewer lifestyle rehabilitation sessions than historical counterparts (mean difference: -2 sessions, p<0.001). No significant differences were observed in exercise rehabilitation attendance, mortality, or readmission risk after propensity score matching. CONCLUSIONS: A nurse-delivered MI-CBT intervention did not enhance cardiac rehabilitation enrolment or attendance. However, programme stability despite pandemic-related challenges suggests resilience. Future research should explore alternative patient engagement strategies and assess MI-CBT fidelity. Findings contribute to understanding participation barriers and inform ongoing service improvements.