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Patient preferences for types of community-based cardiac rehabilitation programme
  1. Shermain Chia1,
  2. Xin Yi Wong2,
  3. Min Li Toon3,
  4. Yi Seah4,
  5. Angela Frances Yap1,
  6. Cindy Lim5,
  7. Hung Yong Tay5,
  8. Warren Fong6,
  9. Lian Leng Low7,
  10. Yu Heng Kwan5,8
  1. 1Duke–NUS Medical School, Singapore
  2. 2Department of Pharmacy, National University of Singapore, Singapore
  3. 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4Faculty of Dentistry, National University of Singapore, Singapore
  5. 5Heart Wellness Centre, Singapore Heart Foundation, Singapore
  6. 6Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
  7. 7Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
  8. 8Program in Health Services and Systems Research, Duke–NUS Medical School, Singapore
  1. Correspondence to Yu Heng Kwan, Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857; yuheng{at}


Introduction Cardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours constraints. Community-based CR is a possible solution.

Objectives To understand the type of community-based CR preferred and identify patient characteristics associated with certain programme combinations.

Methods A cross-sectional survey was administered to a randomised list of patients at risk for or with cardiovascular diseases at two community-based CR centres. Participants were presented with nine hypothetical choice sets and asked to choose only one of the two alternative programme combinations in each choice set. Attributes include support group presence, cash incentives, upfront deposit and out-of-pocket cost. The counts for each combination were tallied and corrected for repeats. Chi-square test and logistic regression were performed to understand the characteristics associated with the preferred CR combination.

Results After correcting for repeats, patients most (85.2%) prefer CR programmes with new group activities, support group, cash rewards, deposit and out-of-pocket cost, and few exercise equipment with physiotherapist presence without the need for monitoring equipment. Patients with more than three bedrooms in their house are less likely (OR 0.367; CI 0.17 to 0.80; P=0.011) to choose the choice with no physiotherapist and few equipment available.

Conclusion This is the first study to explore patients’ preferences for different types of community CR. Higher income patients prefer physiotherapist presence and are willing to settle for less equipment. Our study serves as a guide for designing future community-based CR programmes.

  • cardiac rehabilitation
  • community cardiology
  • delivery of care
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  • Contributors YHK is the principal investigator of the study while XYW, AFY, HYT and CL are co-investigators. WF and LLL reviewed the articles included for the study. SC is the MD candidate conducting this study. She is responsible for study design, reviewing of articles and presentation of data. The first draft of the manuscript was prepared by SC.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval This study has been approved by the National University of Singapore Institutional Review Board (NUS-IRB) guidelines.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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