Rehabilitation needs and adherence among TAVR patients and their caregivers during digital home-based cardiac rehabilitation: a qualitative longitudinal study

While considerable research has examined the effectiveness of digital cardiac rehabilitation, few qualitative studies have explored the dynamic, evolving experiences of post-transcatheter aortic valve replacement (TAVR) patients and their caregivers at different time points during digital home-based cardiac rehabilitation. Longitudinal studies that adopt a dyadic perspective to capture phase-specific changes are especially scarce. This gap limits the development of targeted support strategies. A qualitative longitudinal study was conducted using semi-structured interviews at three time points: pre-discharge, one month, and three months after the digital intervention began. A reflexive thematic approach was used for data analysis. Participants were recruited from a tertiary hospital between January and March 2024. Twenty-two patient-caregiver dyads were included, resulting in 132 individual interviews. Three stage-specific themes were identified along the digital home-based cardiac rehabilitation trajectory: hope and apprehension (pre-discharge), life’s adversities (1 month post-intervention), and adherence divergence in rehabilitation (3 months post-intervention). Pre-discharge, participants expressed hope alongside concerns about disease progression, confusion about digital rehabilitation, and insufficient caregiver capacity. At 1 month, patients struggled with symptoms and reduced social activities, while caregivers faced care-needs mismatch, adverse emotions, inadequate guidance, inaccessible medical services, and life challenges. At 3 months, patients showed either negative responses to disease management or active coping with postoperative physical symptoms. The findings underscore the need for support strategies tailored to specific recovery phases to address dynamic challenges and optimize digital cardiac care for patients after TAVR and their caregivers. Clinically, providing digital device training before discharge can reduce confusion and improve preparedness. Nurse-led remote support one month after the procedure can help manage symptoms, rectify care mismatches, and improve service accessibility. Adjusting personalized rehabilitation plans at three months may further enhance adherence to rehabilitation protocols. This study’s longitudinal dyadic design addresses a current research gap by capturing the evolving experiences of both patients and caregivers across distinct recovery stages, thereby offering new insights for clinical practice. Not applicable.