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

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 24 February 2026
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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