{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:40:38Z","timestamp":1767339638869,"version":"build-2065373602"},"reference-count":52,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,9]],"date-time":"2022-10-09T00:00:00Z","timestamp":1665273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002924","name":"FEDER, through COMPETE2020-POCI","doi-asserted-by":"publisher","award":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"],"award-info":[{"award-number":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"]}],"id":[{"id":"10.13039\/501100002924","id-type":"DOI","asserted-by":"publisher"}]},{"name":"national funds through Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia, I.P. [FCT\/MCTES]","award":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"],"award-info":[{"award-number":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"]}]},{"name":"national funds through Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia, I.P.","award":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"],"award-info":[{"award-number":["POCI-01-0145-FEDER-030011","PTDC\/MEC-CAR\/30011\/2017","UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p &lt; 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p &lt; 0.01). Patients enrolled in CR were more likely to be treated with sacubitril\/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p &lt; 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01\u20131.07), higher education level (adjusted OR 3.31; 95% CI 1.63\u20136.70), stroke (adjusted OR 3.29; 95% CI 1.06\u201310.27), COPD (adjusted OR 4.82; 95% CI 1.53\u201315.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36\u20135.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians\u2019 awareness, patients\u2019 comorbidities, and geographical issues should be pursued.<\/jats:p>","DOI":"10.3390\/jcdd9100344","type":"journal-article","created":{"date-parts":[[2022,10,9]],"date-time":"2022-10-09T20:49:31Z","timestamp":1665348571000},"page":"344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2465-2217","authenticated-orcid":false,"given":"Andr\u00e9","family":"Alexandre","sequence":"first","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8090-2068","authenticated-orcid":false,"given":"Cristine","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"CIAFEL\u2014Physical Activity, Health and Leisure Research Centre, Faculty of Sports, University of Porto, 4200-450 Porto, Portugal"},{"name":"ITR\u2014Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5662-8433","authenticated-orcid":false,"given":"Andreia","family":"Campinas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"given":"Catarina","family":"Gomes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"given":"Sandra","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"ITR\u2014Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal"},{"name":"Unit of Cardiovascular Prevention and Rehabilitation, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Preza-Fernandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"Unit of Cardiovascular Prevention and Rehabilitation, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"}]},{"given":"Severo","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"given":"M\u00e1rio","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"ITR\u2014Laboratory for Integrative and Translational Research in Population Health, 4050-600 Porto, Portugal"},{"name":"Unit of Cardiovascular Prevention and Rehabilitation, Centro Hospitalar Universit\u00e1rio do Porto (CHUPorto), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. 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Cardiovasc. Med."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/10\/344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:48:37Z","timestamp":1760143717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/10\/344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,9]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcdd9100344"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9100344","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2022,10,9]]}}}