Patient characteristics of non-participants and reasons for non-participation in cardiac (tele)rehabilitation—a prospective analysis

Introduction Low participation in cardiac rehabilitation after acute myocardial infarction remains problematic. Cardiac telerehabilitation has emerged as a strategy to improve the uptake by addressing clinical, interpersonal, logistical, and healthcare system-related barriers. In this study, our aim is to determine which patient-related characteristics could lead to non-participation in cardiac rehabilitation, as well as to the reasons for non-participation. Methods In our study, the REHAB + study, cardiac telerehabilitation was implemented in routine clinical practice. In this sub analysis, observational data were collected between November 2021 and 2024 after its implementation in Zuyderland medical center, the Netherlands. After enrolment, patients could choose to participate in center-based cardiac rehabilitation, cardiac telerehabilitation, or were non-participants. Results A total of 328 patients with recent acute myocardial infarction were included. Two hundred (61%) patients participated in center-based cardiac rehabilitation, 64 (20%) in cardiac telerehabilitation, and 64 (20%) were non-participants. Non-participants were older (69 ± 11 years) than participants in center-based cardiac rehabilitation (64 ± 10 years) or cardiac telerehabilitation (61 ± 10 years) ( p < 0.001 ). There were fewer smokers in the cardiac telerehabilitation group (18%), than center-based cardiac rehabilitation (35%) or non-participation (38%). The most common reason for non-participation was a lack of interest, or a failure to acknowledge its necessity (58%). Discussion A high proportion of our myocardial infarction population participated in either cbCR or CTR after trial enrollment. CTR offers remote-access patient education, counselling, and monitoring, which in our study was more appealing to the non-smoking population. Importantly, non-participation in cardiac rehabilitation was influenced by the aging population, mainly for lack of interest, and therefore CR programs should find ways to make their programs more appealing to the aging population. These findings support further work on patient-centered counselling and on adapting rehabilitation pathways to the needs of older patients.