Assessment and predictors of knowledge and attitudes of women toward breastfeeding in the Kurdistan Region, Iraq: a cross-sectional study.

Coronary artery bypass grafting (CABG) remains the primary surgical treatment for complex coronary artery disease []. In China, the number of CABG procedures has increased steadily, reaching 80,016 cases in 2024, reflecting an 11.2% growth []. Despite improvements in intraoperative techniques and in-hospital care, long-term outcomes of CABG patients remain threatened by a critical gap in secondary prevention. Cardiac rehabilitation (CR), a comprehensive intervention strategy encompassing exercise, nutrition, psychological support, and health education, is strongly recommended as a Class I, Level A intervention by international guidelines for its proven efficacy in reducing mortality and hospital readmissions, and improving functional capacity and quality of life [–]. However, CR uptake among CABG patients in China is extremely low [–]. This low participation reflects the uneven distribution of healthcare resources in China, with only 23% of healthcare institutions offering CR programs and fewer than 54% of these providing both phase I and phase II rehabilitation []. Furthermore, postoperative patients are often hesitant to engage in CR due to inadequate health literacy, lack of motivation, and prevalent fear of movement [, ]. In addition, financial barriers further limit CR participation, as CR services are not yet fully integrated into the basic medical insurance system, leaving patients to bear most of the costs out-of-pocket [, ]. This low participation represents a major gap in healthcare delivery, as it is closely associated with poor post-discharge continuity of care, resulting in preventable negative outcomes including significant decline in quality of life, recurrent angina, increased readmission risk, and higher long-term healthcare costs for CABG patients [, –]. The rapid advancement of mobile health and telemedicine offers a promising solution to these barriers. Remote cardiac rehabilitation (RCR) utilizes digital technologies to provide remote guidance and monitoring, potentially overcoming traditional access limitations [, ]. For a health system, RCR represents a scalable and potentially cost-effective strategy to expand CR coverage. Nevertheless, current RCR services remain nascent, with one survey reporting that only 5.7% of patients participating in CR engaged in remote formats [, ]. The successful implementation and uptake of such innovative health service models depend fundamentally on understanding and incorporating patient preferences []. Without robust data on the attributes patients value in an RCR program, developers and clinicians lack the evidence needed to design services that patients will adopt and sustain long-term.