• Giovanna Lombardi Bonini Borges, Mayara Moura Alves da Cruz, Ana Laura Ricci-Vitor, Paula Fernanda da Silva, Sherry Lynn Grace, and VanderleiLuiz Carlos MarquesLCMhttp://orcid.org/0000-0002-1891-3153PhD. Professor, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil..
• PT. Physiotherapist, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
• Sao Paulo Med J. 2022 Jan 1; 140 (1): 108-114.

BackgroundCardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges.ObjectiveTo investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence.Design And SettingObservational, cross-sectional study in public and private CR programs offered in Brazil.MethodsPatients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale.ResultsFrom the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012).ConclusionPublicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.

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