Reducing dropout rates in cardiac rehabilitation among cardiac patients in a vulnerable situation: systematic development and feasibility testing of the Heart Priority Programme.

BACKGROUND

Despite advancements in reducing cardiovascular disease, it remains a major health concern. Cardiac rehabilitation (CR) has a positive impact on morbidity, mortality, and functioning, but faces high dropout rates especially among vulnerable patients, due to social inequalities and insufficiently tailored interventions. To address this, we developed the Heart Priority Programme targeting and supporting cardiac patients at risk of dropout. This study outlines the development of the Heart Priority Programme and share findings from a feasibility test.

METHODS

An iterative three-stage process involving cardiac patients and healthcare professionals from three community healthcare services, guided the development of the programme. Stage 1 included reviewing evidence, consulting stakeholders, and observing practice. In stage 2, a project-group of researchers and healthcare professionals was established to co-produce the programme. Stage 3 included field-testing and local adaptions. Subsequently, the programme was feasibility tested in a single-arm follow-up study across two community healthcare services. Over six months, process data on implementation, acceptability, and mechanism of impact were gathered.

RESULTS

The Heart Priority Programme was development from January 2023 to June 2023, comprising two main parts: 1) an evidence-based identification form with 13 risk factors to identify patients at risk of dropout (referred to as priority patients), and 2) an add-on intervention targeted these patients with three core elements-assigning a contact person, systematic communication, and follow-up. During a six-month feasibility phase, 260 patients were included. Of these, 91 (35%) were identified as priority patients. CR teams found that the programme was relevant, easy to integrate into daily workflow, and applicable in practice. Patient consultations yielded positive feedback on the three core elements of the add-on intervention.

CONCLUSIONS

This paper outlines the development and feasibility test of the Heart Priority Programme, co-produced to identify, and support priority patients. The programme, developed through a three-stage iterative co-production process, was found relevant and easy to implement in community healthcare services. CR teams valued its structured approach to supporting priority patients, and patients found it aligned with their needs. Although initial results are promising, further research is needed to evaluate the programme's effectiveness and suitability for widespread implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06575764, registered retrospectively on 28 August 2024.