Abstract Body: Background Home-based cardiac rehabilitation (HBCR) is linked to fewer hospitalizations than center-based programs and offers greater flexibility and accessibility. Despite these benefits, enrollment is suboptimal, and barriers to participation and completion are not well understood.
Objective To assess patient-reported perceptions and barriers to HBCR.
Methods Using stratified purposeful sampling, we completed 206 surveys among Kaiser Permanente Southern California (KPSC) patients referred to an 8-week HBCR program between January 1, 2023, and December 31, 2024. Telephone surveys were conducted from June to August 2025 among 4 groups: Group 1 (referred but not enrolled), Group 2 (enrolled but did not participate), Group 3 (participated but did not graduate), and Group 4 (graduated). Sampling targeted ~50% of patients in Group 1 and ~16% in each of Groups 2–4. Surveys assessed motivations and barriers to enrollment and completion, technology use, and qualitative feedback on the HBCR program.
Results Overall there were 102, 35, 34, and 35 survey completions in Groups 1–4, respectively. Most patients (65%) recalled their doctor discussing HBCR. In Group 1, the most common enrollment barriers were preference for self-management (35%) and unfamiliarity with HBCR (31%). Among Groups 2–4, most reported enrolling to help manage their condition (89%) and improve their health (87%). In Group 2, the main barrier to participation was feeling overwhelmed by information or technology (58%), while in Group 3, the main barrier to completion was not noticing health improvement (56%). Most Group 4 patients stated they completed the program to improve their health (97%). Overall, 62% of patients agreed they could use technology applications, 57% could set up video chats, and 51% could resolve basic technical issues without assistance. The most common suggestion for improvement was to extend the program to 6–12 months. Patients valued nurse and staff support, as well as the program’s accountability, flexibility, and education.
Conclusion HBCR may be a convenient alternative to center-based programs, but patients reported barriers including self-management preference, limited awareness, and technology challenges. Stronger physician communication, structured onboarding, and longer program duration may improve participation and cardiovascular outcomes. Despite telehealth support, additional or tailored help may be needed to address these barriers and increase participation.