The need for and perception of cardiac rehabilitation among people with ischemic heart disease and heart failure in Pakistan: is a digital home-based programme the solution?
Abstract
Background Cardiac rehabilitation (CR) reduces hospital admissions and improves health-related quality of life in ischaemic heart disease (IHD) and heart failure (HF), but access is limited in low- and middle-income countries, including Pakistan, where previous data suggest home-based CR may be acceptable. We aimed to assess patients’ preferences for, and preferred modes of delivery of, home-based cardiac rehabilitation (CR), as well as their digital readiness, to inform programme development. Methods An interviewer-administered cross-sectional survey, with responses recorded electronically in REDCap, was conducted of adults with IHD or HF, recruited from the Peshawar Institute of Cardiology and through community outreach in Khyber Pakhtunkhwa, Pakistan, between April and June 2026. The primary outcome was willingness to participate in a digital home-based CR programme. Free-text responses to a final open-ended question about views on using a digital programme were analysed using inductive qualitative content analysis. Results Among 310 participants (mean age 55.3 years; 79% men), 254 (82%, 95% CI 77% to 86%) were willing to participate in a digital home-based CR programme and 56 (18%) were unwilling or unsure. Participants who expressed willingness, most often chose family-supported home digital delivery (66%), followed by a paper manual (29%) or app/website (28%) with health-worker support, and a digital–hospital hybrid (25%); few chose hospital (7%) or community (6%) group programmes. Only 55% owned a smartphone and 46% had regular internet access, yet 85% of willing participants reported a family member able to support them. Six themes were developed, including comprehension needs, family support and digital barriers. Conclusion Most surveyed Pakistani patients with IHD or HF were willing to participate in digital home-based CR, A digital programme was the preferred format, most commonly with support from a family member, despite relatively limited digital access and lower levels of independent digital readiness.