Adherence to outpatient cardiac rehabilitation and related factors in STEMI after PCI in China: a sequential explanatory mixed method study protocol.

BACKGROUND: Acute myocardial infarction remains a major contributor to global morbidity and mortality. Cardiac rehabilitation is widely recognized as an essential component of the comprehensive medical management for patients with ST-elevation myocardial infarction, especially among those who have undergone percutaneous coronary intervention. Adherence to cardiac rehabilitation encompasses patient collaboration with a healthcare provider, active involvement in the treatment regimen, and persistence in practice, characterized by self-efficacy and relapse prevention. Outpatient cardiac rehabilitation constitutes the second phase of the continuum of care, bridging the inpatient and long-term maintenance stages. However, adherence to outpatient cardiac rehabilitation programs in China remains suboptimal. The factors influencing outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention have not yet been fully elucidated.

AIMS: To investigate the status and influencing factors of adherence to outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention one month after discharge in China and gain a deeper understanding of this phenomenon of interest.

METHODS: An explanatory sequential mixed-methods design will be employed to conduct this study with three phases. The first phase is a quantitative study with a cross-sectional design to assess the level of adherence to outpatient cardiac rehabilitation and related influences based on the Health Belief Model among 198 patients with ST-elevation myocardial infarction after percutaneous coronary intervention in two tertiary hospitals in Zhenjiang, Jiangsu Province, China. The second phase is followed by a qualitative study to explore the patients' perceived facilitators and barriers to adherence to outpatient cardiac rehabilitation. Purposive sampling, semi-structured interviews, and conventional content analysis approaches will be used to collect and analyze the data. The final phase links to integrating the data and developing a targeted strategy to improve adherence to outpatient cardiac rehabilitation among patients with ST-elevation myocardial infarction after percutaneous coronary intervention. The nominal group technique and "weaving techniques" will be implemented in accordance with the results of the preceding two phases.

DISCUSSION: A targeted strategy to improve outpatient cardiac rehabilitation adherence would be designed considering the factors affecting adherence to outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention.

CLINICAL TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry: ChiCTR2400080035.