18 Healthcare professionals’ perspectives on sex and ethnic disparities in UK cardiac rehabilitation programmes: a Delphi study

<h3>Background</h3> Cardiovascular rehabilitation (CR) is a crucial element in the management of coronary heart disease (CHD). However, only 52% of those eligible for CR participate in it, with lower engagement among females and minority ethnic groups. Despite reported barriers to participation, healthcare professionals’ (HCPs) perspectives on referral and attendance remains unexplored. <h3>Aim</h3> To explore the perspectives of HCPs on factors influencing referral and attendance to CR services in the UK. <h3>Methods</h3> A three-round Delphi study (May to September 2023) involved 38 HCPs recruited via snowball sampling. In Round One, 12 open-ended questions enquired about participants’ views on staff competencies, core components of CR, referral criteria, referral pathways, and the associations between sex and ethnicity related to referral and attendance. Content analysis informed a structured five-point Likert scale questionnaire used in Round Two. Consensus was defined a priori as ≥ 70% agreement among the participants. In Round Three, participants were asked to retake the questionnaire after receiving feedback for individual and group responses. <h3>Results</h3> Consensus was achieved on 53 of the 108 statements, covering 10 key aspects of CR. HCPs acknowledged significant disparities in UK CR programmes, attributing these to knowledge gaps. HCPs emphasised the need for educational initiatives within general practitioner (GP) surgeries and direct referral pathways as effective strategies for enhancing sex-specific referrals to phase III CR. Furthermore, HCPs suggested education for hospital ward staff on inclusion and cultural training, alongside building relationships with local communities, to improve ethnic-specific referrals to CR (table 1). <h3>Conclusion</h3> This study highlights HCPs perspectives on referral and attendance to CR programmes in the UK, focusing on sex and ethnicity. HCPs emphasised the urgent need for initiatives to enhance clinicians’ knowledge and ensure inclusivity in CR services. Future research should build on these findings to promote equitable access to CR for diverse UK populations.