Background: Despite evidence supporting the inclusion of transient ischemic attack (TIA) and mild stroke patients in cardiac rehabilitation, implementation of integrated cardiovascular rehabilitation (CVR) programs (TIA, mild stroke and coronary heart disease) in existing health services remains poor.
Aims: Identify factors influencing CVR implementation success/failure, and evaluate CVR implementation outcomes (reach, effectiveness, adoption, implementation, maintenance) from clinician perspectives.
Methods: This mixed-methods process evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Quantitative process-level data and qualitative data (semi-structured interviews, field notes, observations) were collected throughout CVR implementation. Qualitative data was deductively coded to the Consolidated Framework for Implementation Research. All data was mapped to RE-AIM dimensions.
Results: Reach was 44% (140/315) of the eligible patient population, with referral adoption highest at site 1 (74%), influenced by larger referral teams and program awareness. Clinicians perceived CVR as effective, but more evidence is needed. CVR was implemented as intended, with fidelity influenced by staffing and increased clinician confidence in delivery, and 66% (46/70) of patients completing >5 of 6 sessions. Clear referral pathways and access to resources (staffing, equipment, multifaceted education) to support clinicians are necessary for CVR maintenance.
Conclusion: Greater program awareness and streamlining referral pathways are indicated to improve reach and adoption. Access to resources (staffing, multifaceted education) to support clinicians, and increasing clinician confidence in CVR delivery, are key for implementation and maintenance. Findings will provide clinicians with the evidence base to implement CVR into routine secondary prevention care for TIA and mild stroke patients.