Motivational Interviewing and Cognitive Behavioural Therapy in the Auckland Cardiac Rehabilitation Programme: A Propensity Score-Matched Study - 24/02/26

Doi : 10.1016/j.hlc.2025.10.006

Paul W. Marshall, PhD ^a,^⁎ , Jocelyne R. Benatar, PhD ^a,^b, Paul O’Halloran, PhD ^c,^d, Natalie M.V. Morrison, PhD ^e, Tia Lindbom, MSc ^a, Michael Kingsley, PhD ^a,^f

^a Department of Exercise Sciences, Faculty of Sciences, University of Auckland, Auckland, New Zealand

^b Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

^c School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia

^d Centre for Sport and Social Impact, La Trobe University, Melbourne, Vic, Australia

^e Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia

^f Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Melbourne, Vic, Australia

^∗ Corresponding author at: Department of Exercise Sciences, University of Auckland, Building 907 Suiter Street, Newmarket, Auckland 1023, New Zealand Department of Exercise Sciences University of Auckland Building 907 Suiter Street Newmarket Auckland 1023

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Abstract

Aim

Suboptimal enrolment and engagement in cardiac rehabilitation remains a persistent issue worldwide. This study evaluated the impact of a nurse-specialist-delivered motivational interviewing (MI) and cognitive behavioural therapy (CBT) intervention on cardiac rehabilitation enrolment, attendance, all-cause mortality, and readmission in Auckland’s 2022 cardiac rehabilitation programme compared with a propensity score-matched historical cohort.

Method

This study included all patients (n=797) referred to Auckland’s outpatient cardiac rehabilitation programme in 2022. Outcomes were compared with a retrospective cohort of 3,331 patients enrolled in the Auckland cardiac rehabilitation programme (2016–2020), from which a propensity score-matched historical cohort was created (n=779 per group, 97.7% retention). Data were extracted from the Auckland health district medical database. Primary outcomes included cardiac rehabilitation enrolment and attendance, all-cause mortality, and readmissions (1.5-year average follow-up). Analysis included comparisons of proportions, inferential statistics, Cox proportional hazards, and logistic regression.

Results

Cardiac rehabilitation enrolment in 2022 was 54.4%, with 40.2% of patients attending at least one lifestyle session (mean 4.0±2.7 sessions) and 32.8% attending at least one exercise session (mean 10.2±6.9 sessions). The intervention did not improve enrolment, attendance, mortality, or readmission rates. Patients in 2022 attended fewer lifestyle rehabilitation sessions than historical counterparts (mean difference: -2 sessions, p<0.001). No significant differences were observed in exercise rehabilitation attendance, mortality, or readmission risk after propensity score matching.

Conclusions

A nurse-delivered MI-CBT intervention did not enhance cardiac rehabilitation enrolment or attendance. However, programme stability despite pandemic-related challenges suggests resilience. Future research should explore alternative patient engagement strategies and assess MI-CBT fidelity. Findings contribute to understanding participation barriers and inform ongoing service improvements.

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Keywords : Cardiac rehabilitation, COVID-19, Nursing, Mortality, Exercise, Education