Home›Cardiology› Nursing-led strategies address patient, systemic, and socio-cultural barriers to cardiac rehabilitation participation
Nursing-led strategies address patient, systemic, and socio-cultural barriers to cardiac rehabilitation participationNurses help heart failure patients overcome barriers to cardiac rehab
Frontiers in MedicinePublished October 27, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Note that nursing-led coordination and education can mitigate systemic and personal barriers to cardiac rehabilitation.
This systematic review synthesized 17 studies to identify barriers to cardiac rehabilitation participation and the role of nursing in improving referral, enrollment, attendance, adherence, and program completion in adults with heart failure. The review highlights three primary categories of barriers: patient-related (health literacy, symptom burden, and exercise-related fear), systemic/structural (fragmented referral pathways, limited availability, and transportation issues), and socio-cultural (language barriers and socioeconomic disadvantages).
Nursing-led interventions were identified as key facilitators to mitigate these barriers. These include care coordination, patient education, motivational support, and structured follow-up. The review also notes the utility of automatic referral systems and diverse delivery models, such as home-based, hybrid, and digitally enabled rehabilitation programs supported by clinical supervision.
While the review identifies clear roles for nursing staff in advocacy and coordination, it does not provide quantitative evidence or specific effect sizes for these interventions. Clinical application is focused on utilizing nursing staff to improve patient engagement and navigation through complex rehabilitation systems.
How this fits prior evidence
This systematic review addresses a gap in understanding how nursing interventions can overcome barriers to cardiac rehabilitation. While previous coverage has focused on pharmacological treatments like Dapagliflozin for heart failure and Qili Qiangxin plus conventional medicine for post-myocardial infarction markers, this review focuses on the organizational and supportive role of nursing staff in improving rehabilitation participation.
Living with heart failure is hard enough without the extra hurdle of trying to get better. Many patients want to join cardiac rehabilitation programs but find themselves blocked by personal fears, physical symptoms, or a lack of understanding about their health. These barriers can make it feel impossible to stay active and improve their heart health.
Researchers looked at 17 studies to see what stops people from joining these programs. They found that things like fear of exercise, transportation problems, and living in rural areas make it very difficult for patients to get the care they need. These issues hit women, migrants, and people in rural areas especially hard.
Nurses can bridge this gap. The research shows that nurses can help by coordinating care, providing clear education, and offering emotional support. By using automated referral systems and offering home-based or digital options, nurses help patients overcome hurdles like distance and complex schedules to complete their rehabilitation.
What this means for you:
Nurses can help heart failure patients overcome physical, social, and logistical barriers to complete cardiac rehab.
Common questions
What stops people from joining heart failure rehab?
Many people face personal hurdles like fear of exercise, heavy symptoms, and low health literacy. They also face structural problems like living in remote areas, having no way to get to a clinic, or struggling with language barriers and limited transportation.
How can nurses help patients with heart failure?
Nurses can provide vital support through care coordination, patient education, and motivational support. They can also help by setting up automatic referral systems and offering different ways to participate, such as home-based or digitally enabled rehabilitation models.
Who is most affected by these barriers?
Certain groups face harder challenges. The research shows that women, migrants, people living in rural areas, and those facing socioeconomic disadvantages are disproportionately affected by the barriers to joining cardiac rehabilitation programs.
BackgroundHeart failure (HF) is a major cause of morbidity, reduced quality of life, and repeated hospital admissions worldwide. Cardiac rehabilitation (CR) is a guideline-recommended intervention that improves functional capacity, quality of life, and clinical outcomes in patients with HF. Despite its proven benefits, participation in CR remains consistently low, suggesting the presence of significant barriers at patient, provider, organizational, and health-system levels. Nurses play a central role throughout the heart failure care continuum and are well positioned to influence referral, enrolment, adherence, and long-term engagement in rehabilitation programmes.AimThis systematic review aimed to identify barriers affecting participation in cardiac rehabilitation among adults with heart failure and to examine the role of nursing in improving referral, enrolment, attendance, adherence, and programme completion.MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Five electronic databases (PubMed, CINAHL, EMBASE, Scopus, and MEDLINE) were searched for peer-reviewed studies published between 2015 and 2025. Studies were eligible if they involved adults with heart failure, investigated barriers to cardiac rehabilitation participation, and included a nursing perspective, role, or intervention. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT 2018). Data were synthesized using narrative and thematic analysis.ResultsFrom 1,509 identified records, 17 studies met the inclusion criteria. Four major themes emerged: patient-related barriers, systemic and structural barriers, socio-cultural and equity-related barriers, and nursing-related facilitators. Common barriers included health literacy limitations, symptom burden, exercise-related fear, comorbidities, fragmented referral pathways, limited-service availability, geographic isolation, transportation difficulties, digital accessibility challenges, language barriers, and socioeconomic disadvantages. Women, migrants, rural populations, and socially vulnerable groups were disproportionately affected. Facilitators included nurse-led care coordination, patient education, motivational support, structured follow-up, automatic referral systems, and home-based, hybrid, and digitally enabled rehabilitation models supported by ongoing clinical supervision.ConclusionParticipation in cardiac rehabilitation among patients with heart failure is influenced by complex and interconnected barriers that extend beyond individual motivation. Nurses play a critical role in addressing these challenges through education, care coordination, behavioral support, and advocacy. Strengthening nurse-led interventions and expanding flexible, equitable rehabilitation models may improve cardiac rehabilitation referral, engagement, and adherence among people living with heart failure.
