Implementing Cardiac Rehabilitation as a First-Line Treatment for Stable Angina Pectoris: PERSPECTIVES OF CARDIOLOGISTS AND PATIENTS

Purpose: Cardiac rehabilitation (CR) is a promising treatment for patients with stable angina pectoris (SAP) and has been postulated as a safe and effective alternative to revascularization in low-risk patients. We assessed the barriers and facilitators for the implementation of CR for patients with SAP. Methods: We interviewed 12 clinicians (cardiologists and CR case managers) and 6 patients to assess perceived and expected barriers and facilitators in choosing CR as first-choice treatment for SAP in the Netherlands. The interviews were analyzed both inductively and deductively using the theoretical domains framework. Results: We found a total of 44 barriers and 28 facilitators across 8 themes. Clinicians reported the following key barriers: lack of evidence and clarity in guidelines; knowledge gaps about the outcomes, treatment indication, and content of CR; higher perceived effort to discuss CR compared with a revascularization; a lack of support from colleagues and authorities; suboptimal treatment decision-making conditions; beliefs that affect openness to CR; and the organization/funding of care. Clinicians indicated these facilitators: their belief in CR and motivation to provide the best and affordable care. Patients reported no major barriers. As facilitators, patients indicated openness to CR and trust in the clinician advice. Conclusion: Clinicians experience barriers to propose CR as an initial treatment strategy rather than revascularization in patients with SAP despite their motivation and belief in CR. Clinicians require more evidence, awareness of the existing evidence, clarity in guidelines, and support from their professional association.