Mapping rehabilitation pathways after cardiac surgery: Identifying key points for patient involvement and gaps in care.

BACKGROUND: Cardiac rehabilitation in Denmark is cross-sectional and decentralised to municipalities, resulting in different pathways and practices. A comprehensive overview of these variations and their impact on the rehabilitation process following cardiac surgery is lacking. AIM: This study aims to map the rehabilitation pathways after cardiac surgery, and to identify key interactions between patients and clinicians that influence rehabilitation outcomes and patient experiences. METHODS: A qualitative multi-method study was conducted using metro mapping methods, including document analysis, stakeholder consultations, practice observations and go-along interviews across multiple sites in Central and Northern Denmark Regions. RESULTS: Mapping revealed significant variability in cardiac rehabilitation pathways across healthcare settings, including diverse referral, enrolment, content, delivery methods, and follow-up procedures, involving multiple clinicians. A consistent finding across all pathways was both a prolonged transition from in-hospital phase 1 to outpatient phase 2 rehabilitation, resulting in a gap of care, and minimal patient involvement in decision-making and planning during the early phase of recovery. CONCLUSION: This study provides a comprehensive overview of current rehabilitation pathways following cardiac surgery, revealing significant variability and challenges. Our findings emphasise the need for a person-centred redesign of the cardiac rehabilitation pathway with improved sector transitions. Our findings provide guidance for clinicians and underscore the importance of clear legal frameworks, consistent guidelines, and co-design of cardiac rehabilitation programmes with patients. Strengthening these areas could promote greater patient engagement, reduce variability in service delivery, and ultimately lead to better patient outcomes and experiences.