Perspectives of Policymakers on Barriers to and Enablers of the Uptake of Cardiac Rehabilitation in Saudi Arabia: A Qualitative Study.

Objectives: This study aimed to identify the barriers to and enablers of secondary prevention care and cardiac rehabilitation (CR) utilization by patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) from the perspective of policymakers. Methods: A qualitative study involving an interpretive descriptive design was conducted through recorded semistructured interviews with key decision-makers in cardiology care in Saudi Arabia. The analysis was guided by the updated Consolidated Framework for Implementation Research (CFIR), which informed the resulting themes. Results: Interviews were conducted with nine key decision-makers: four directors of major cardiac centers, four heads of cardiac rehabilitation units, and one president of a specialized cardiac society. Data coding identified 16 CFIR constructs as barriers, with seven prioritized by the participants. The most frequently cited barriers included lack of CR facilities, shortage of trained staff, and insufficient knowledge of CR among cardiologists. Seventeen constructs emerged as enablers to aid in overcoming these challenges, with nine receiving high consensus among policymakers. Key enablers included implementing alternative models, such as home-based programs; enhancing cardiologists' understanding of CR benefits; and involving higher authorities for support. Conclusions: This study highlights the significant barriers to CR utilization and proposes solutions to facilitate the implementation of these programs from the perspective of healthcare leaders. Successful implementation requires improved communication within institutions, collaboration with the broader healthcare system, and engagement with other stakeholders, such as the private sector, to expand access and ensure comprehensive service delivery.