9 What is the role of health inequalities in decision to decline cardiac rehabilitation?

<h3>Background</h3> Health inequalities (HI) can be contributing factors in declining Cardiac Rehabilitation (CR). Understanding the reasons for declining CR informs services of how to make programmes more equitable and to reduce perceived barriers to participation. <h3>Aim</h3> Explore the role of HI in patients’ decision to decline CR assessment and subsequent programme at University Hospitals of Leicester (UHL). <h3>Methods</h3> Patients received telephone contact by CR staff ≤ 5 days after discharge and were offered CR. Of those eligible, 261 patients declined UHL CR between Jan 2023 and October 2023. Patients received written invitation to attend a focus group led by CR staff to discuss the barriers and reasons for declining CR offer. Focus group findings were transcribed and thematic analysis was completed. Relative deprivation was determined by the Index of Multiple Deprivation measure. <h3>Results</h3> 9 patients attended a focus group (table 1) and two main themes were established; Lack of understanding of CR and awareness of referral. Other feedback included CR offer being too early in the recovery process, unaware of variety of CR modes available and co-morbidities. No obvious HI were identified with location, cost or transport not being barriers to participation. Patients’ perception was a thorough and adequate explanation of benefits and components of CR was not provided by either UHL ward or CR staff. <h3>Conclusion</h3> CR was declined due to a lack of participant knowledge and understanding of the service. Contact with experienced ward and CR staff post-discharge did not provide adequate information on the benefits and importance of CR. Work should be done to ensure appropriate information and education is provided to meet health literacy needs and to aid patient understanding. The lack of diversity in ethnicity and deprivation in the group was a main limitation and future work should be done to target typically under-represented groups.