Barriers to Cardiac Rehabilitation in Saudi Arabia: A Scoping Review

Background: Cardiac rehabilitation (CR) is considered a cornerstone of secondary prevention for cardiovascular disease (CVD); however, it remains underutilized and underdeveloped in Saudi Arabia. Objective: This scoping review aimed to analyze the existing evidence on barriers affecting the implementation and participation in CR programs across Saudi Arabia. Methods: A comprehensive search was conducted in MEDLINE, PubMed, Google Scholar, and ScienceDirect for studies published between 2015 and 2025. Eight national studies were included, examining perspectives from physicians, nurses, physiotherapists, and patients. Data were thematically analyzed and categorized into four domains—service delivery and policy, workforce and training, awareness and culture, and patient-related factors—classified under two levels: system and personal. Results: Findings from eight included studies revealed system-level barriers, including a shortage of CR centers, insufficient workforce training, fragmented policies, and limited funding. Personal-level barriers included low awareness, cultural constraints, and patient-related factors such as fatigue, anxiety, comorbidities, and limited access. Together, these challenges delay the normalization of CR within cardiac care pathways. Conclusions: A coordinated national framework is needed to integrate CR into post-cardiac care, supported by professional training, sustainable funding, and culturally sensitive public engagement. The most urgent priorities include establishing national CR guidelines, expanding workforce development pathways, and improving awareness of CR among patients and healthcare providers. Addressing these barriers is essential to expanding CR services, enhancing patient outcomes, and aligning healthcare priorities with Saudi Arabia’s Vision 2030 goal of an equitable and prevention-oriented healthcare system.