Barriers to Cardiac Rehabilitation in Private and Public Sector Hospitals of Lahore

Abstract

Background: Cardiac rehabilitation plays a pivotal role in improving outcomes for patients with a variety of cardiovascular diseases. Despite its widely proven benefits, including reduced mortality and morbidity rates, enhanced functional capacity, it remains underutilized in public as well as private sector hospitals of Lahore. Barriers to cardiac rehabilitation, a significant concern, limit the proper delivery of this crucial healthcare service. Objective: To identify barriers to establishing cardiac rehabilitation in public and private hospitals in Lahore. Methodology: Data were collected in this cross-sectional study from the social security hospital, Multan Road, Sir Ganga Ram Hospital, Lahore, and Mansoorah Teaching Hospital, Lahore. The cardiac rehabilitation barrier scale questionnaire was also sent electronically using Google Forms. A sample size of 194 cases was calculated with a 95% confidence level. The inclusion criteria were patients aged 30 to 70 years, both male and female were selected using convenience sampling, having a history of coronary artery bypass grafting, percutaneous coronary interventions, and post-myocardial infarction patients. Patients with a history of acute cardiovascular disease, cardiogenic shock, acute heart failure, severe arrhythmia, hypotension, chest pain, or angina were excluded. Descriptive statistics, including mean and standard deviation, were used to summarize demographic characteristics and individual barrier items on the CRBS scale. Frequencies and percentages were calculated to identify the most prevalent barriers to cardiac rehabilitation among the 194 participants. An independent samples t-test was applied to compare barrier scores between public and private sector hospitals. The analysis revealed statistically significant mean differences for several key barriers, including cost, lack of awareness, negative attitude toward cardiac rehabilitation, and insufficient doctor referral, with higher scores consistently observed in public hospitals. Results: Barriers are present in both sectors of hospitals, but at a higher ratio in public sector hospitals. In total, 194 participants of study, the main barriers assessed were doctor referral 46%, cost 46% lack of awareness 46% negative attitude towards cardiac rehab 53% and fatigue 47%. Conclusion: Many factors are affecting the lack of cardiac rehabilitation practices in Pakistan, those factors include cost, lack of awareness, and general negative attitude towards cardiac rehabilitation and doctor referral rates.