Optimizing cardiac telerehabilitation programs: psychological, social, and implementation factors

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BACKGROUND: Cardiac telerehabilitation (tele-CR) uses home-based or hybrid delivery to provide multidisciplinary cardiac rehabilitation reducing travel and time barriers. However, tele-CR outcomes may be influenced by engagement, therapeutic relationships, and contextual and implementation constraints. This narrative review synthesizes evidence on psychological, social, and implementation factors that optimize tele-CR uptake, adherence, and effectiveness. METHODS: We conducted a targeted literature search in PubMed, Scopus, PsycINFO, and Embase (January 2021-January 2026). We included randomized and observational studies, qualitative and mixed-methods research, and systematic reviews/meta-analyses involving adults with cardiovascular disease participating in home-based, hybrid, or fully remote tele-CR. Reporting followed the Scale for the Assessment of Narrative Review Articles (SANRA). RESULTS: Tele-CR is a sociotechnical, biopsychosocial intervention in which outcomes emerge from the integration of digital tools (monitoring, feedback, interfaces), clinical workflows, and patients' everyday contexts. Self-monitoring and structured feedback can strengthen self-efficacy and habit formation when data are interpretable and linked to actionable guidance. Remote delivery can reduce non-verbal cues, but continuity may improve through routine check-ins and responsive follow-up. An equity-by-design approach tailors delivery to connectivity, privacy, health literacy, language needs, and caregiver capacity. Across studies, feasibility and acceptability were associated with usability, support, and perceived value. CONCLUSIONS: Tele-CR can broaden access to cardiac rehabilitation, but scalable benefit requires relationship-centred, equity-oriented service design. Priorities include calibrating monitoring to clinical actionability, reducing cognitive load through plain-language interfaces and structured onboarding, integrating routine mental health screening and patient-reported outcomes, supporting caregivers as end-users, and embedding implementation metrics and continuous quality improvement alongside clinical outcomes.

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