Referral to cardiac rehabilitation (CR) is often incomplete. Those most likely to benefit are less likely to be offered the service and there has been little systematic exploration of the reasons for this situation in the UK. The purpose of this study was to investigate CR staff perceptions in relation to aspects of referral to CR programmes. In a prospective cross-sectional study, a 24-item questionnaire regarding perceptions of referrals was mailed to 115 referring staff of 23 CR out-patient programmes in the North West of England. The response rate was 85 (74%). The most common factors cited for low referrals were: funding limitation 57 (67%), limited facilities 56 (66%), shortage of trained staff 51 (60%) and patients” poor physical ability 50 (59%). Fifty-three (62%) respondents suggested participation would increase if CR were offered by a medical practitioner. Sixty-one (72%) respondents felt they provided CR according to recommended guidelines. Seventy-nine (93%) of the respondents agreed CR was necessary or appropriate for most cardiac patients and 76 (89%) reported CR offered more to patients than secondary prevention. The study concludes that CR programmes should be audited better and physicians need to be more actively involved in recruiting patients to programmes. Better funding is required to increase facilities and staff training to improve referral of patients.