Primary healthcare professionals’ views on cardiovascular rehabilitation and disease management

Abstract

Background Despite its benefits, cardiovascular rehabilitation (CR) is underutilised and not widely accessible globally, including in Brazil, where public CR programs are linked to the Unified Health System (SUS). Limited availability, significant access barriers, and the essential role of professionals in Basic Health Unit (BHU) — that is, community-based facilities that deliver primary healthcare services — impact CR’s reach in Brazil. Aim To explore the perspectives and experiences of BHU professionals regarding CR and the management of cardiovascular diseases (CVDs) in Adamantina, Brazil. Methods A qualitative approach was used, involving nine focus groups with 71 BHU healthcare providers, including nurses, physicians, nursing assistants, community health workers, physiotherapists, and nutritionists. Thematic analysis was conducted. Findings Participants had an average age of 39.5 years and 9.9 years of professional experience; 71.8% held a university degree or higher. On average, they managed 584 patients monthly, with 53% diagnosed with CVD. Five main themes were generated: (1) comprehensive management of CVD, (2) roles of BHU professionals, (3) awareness of CR, (4) challenges in patient adherence to behaviour change, and (5) obstacles in accessing CR services. Participants demonstrated limited knowledge of CR, with inadequate referral processes and infrastructure challenges impeding effective CR integration. Discussion Findings highlight the need to address knowledge gaps, improve referral pathways, and enhance infrastructure to better integrate CR into primary healthcare. Despite recognising CR’s importance, BHU professionals face significant challenges in its implementation and promotion. Conclusion Strengthening professional education, optimising referral systems, and improving infrastructure are critical to increasing CR accessibility and improving outcomes in primary care settings.