Researchers: Robert Klemphner¹, Irene Nabutovsky¹

Background: Telemedicine has advanced significantly, offering benefits such as reduced hospitalizations, improved treatment adherence, and enhanced patient satisfaction. Remote Cardiac Rehabilitation (RCR) programs have proven to be as effective as traditional models. Although RCR has been part of Israel's national health basket since 2018, patient participation remains limited. The transition period from hospital discharge to rehabilitation is often fragmented, leading to delays and poor adherence. Understanding patient needs and barriers during this critical phase is essential to optimize outcomes.

Objectives: This study aimed to (1) map the patient journey from hospitalization to the completion of RCR; (2) identify transition challenges from the patient’s perspective; (3) assess attitudes toward health, reasons for non-participation, dropout, and satisfaction; and (4) examine the relationship between perceived health control (Patient Activation Measure, PAM) and adherence, satisfaction, and engagement in supportive services.

Method: A cross-sectional study was conducted among 700 patients at various stages: hospitalized, pre-rehabilitation, inpatient rehab, active RCR participants, and RCR completers/dropouts. Data were collected via anonymous questionnaires assessing attitudes, satisfaction, and barriers, and complemented by objective measures from the DATOS platform. Multivariate models were used for analysis.

Findings: While 88% received a referral to cardiac rehab, 23% were referred outside the hospital system, often by self-initiative. Barriers included limited access to community physicians, bureaucratic delays (e.g., Tofes 17), and long wait times. Awareness of RCR was low, yet over 70% of those not enrolled showed interest. Higher PAM scores predicted better adherence, satisfaction, and completion. Women and younger patients were more likely to request post-discharge support.

Conclusions: Multiple logistical and informational barriers hinder smooth transition to RCR. Patient activation level (PAM) is a significant predictor of successful engagement and could guide personalization of services.

Recommendations: Hospitals should adopt proactive discharge referral processes, implement Health Navigator support, raise RCR awareness via digital tools, and utilize PAM scores to personalize rehabilitation pathways and improve timely access.

Research end date: 05/2025