Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

Abstract

Background

While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake.

Objectives

To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing.

Patients and Methods

This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist.

Results

Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making.

Conclusion

Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Keywords:

• Cardiac rehabilitation
• acute myocardial infarction
• adaptive tasks
• normalization process theory

Acknowledgements

The authors would like to thank all participants and their caregivers for sharing the actual experiences and to acknowledge our research partner and its faculty staff in which Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine. Xiyi Wang would like to thank K.C. Wong Foundation Fellowship to support her research at King’s College London.

Authors contributions

Xiyi Wang and Li Xu conceptualized and conducted the study. Xiyi Wang and Geraldine Lee led the writing and revision of the manuscript. Xunhan Qiu was responsible for participants recruitment. Dandan Chen, Ping Zou, and Hui Zhang verified the data extraction and reviewed and revised the manuscript.

Disclosure statement

The authors declare that they have no conflicts of interest.

Data availability statement

The data is available upon a reasonable request from the corresponding author.

Additional information

Funding

This study was supported by the Shanghai Sailing Program (grant number 21YF1422400), Shanghai Jiao Tong University School of Nursing: Application-oriented Undergraduate Education Program (grant number HLDC21-09), and Shanghai Jiao Tong University School of Medicine: Nursing Development Program (grant number SJTUHLXK2021)