Barriers to Cardiac Rehabilitation Uptake among Patients with Heart Failure in Rural Thailand: A Cross-Sectional Study

Background: Cardiac rehabilitation (CR) improves outcomes in patients with heart failure (HF), yet participation remains limited in Thailand. This study aimed to identify barriers to CR participation among patients with HF in rural Thailand. Methods: A cross-sectional study was conducted among 55 adults with HF recruited purposively from a rural tertiary hospital between August 2025 and May 2026. Data were collected using a demographic and clinical questionnaire and the Thai version of the Cardiac Rehabilitation Barriers Scale (CRBS-T). Descriptive statistics summarized participant characteristics and perceived barriers. Exploratory subgroup comparisons were performed using nonparametric tests, and open-ended responses were categorized by recurring themes. Results: Participants had a median age of 61 years, and 67.3% were female. None had previously been referred to CR, and awareness of available services was limited. Logistical factors had the highest domain mean score (2.62, SD 1.16), followed by perceived need for CR (2.53, SD 0.93). Prominent barriers included preferring independent health management, believing that people with heart disease could remain healthy without CR, family responsibilities, adverse weather, and travel difficulties. Open-ended responses highlighted inadequate social support (32.7%), comorbidities (23.6%), limited CR knowledge and awareness (16.4%), and work or family responsibilities (16.4%). Exploratory analyses indicated higher barrier scores among men and participants with previously diagnosed HF. Conclusion: Patients with HF in rural Thailand experience substantial informational, logistical, and social barriers to CR participation. Improving patient education, strengthening referral pathways, and piloting accessible community-based, home-based, or telehealth-supported CR programs may help improve uptake.