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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Socioeconomic Inequalities and Predictors of Cardiac Rehabilitation Referral: Real-World Evidence
José Afonso Rocha1, Luís F Azevedo, Alberto Freitas
1From the Cardiovascular Rehabilitation Unit, Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário São João, Porto, Portugal (JAR); Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal (JAR); Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal (LFA, AF); Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal (JCSC); and Faculty of Medicine, University of Porto, Porto, Portugal (JCSC).
Insights
Cardiac rehabilitation referral after acute coronary syndrome is low, especially for women, older patients, and those from lower socioeconomic backgrounds. New strategies are needed to address these access inequities in cardiac rehabilitation programs.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Acute coronary syndrome (ACS) necessitates comprehensive management, including cardiac rehabilitation (CR).
- Referral and participation in CR programs are crucial for secondary prevention and improved patient outcomes.
- Existing disparities in healthcare access may impact CR referral rates among vulnerable populations.
Purpose of the Study:
- To identify sociodemographic and clinical factors associated with referral to cardiac rehabilitation following an acute coronary syndrome.
- To evaluate the rate of cardiac rehabilitation referral and participation in a university hospital setting.
- To highlight potential inequities in access to cardiac rehabilitation services.
Main Methods:
- Retrospective analysis of 2814 hospitalizations for acute coronary syndrome between 2017 and 2019.
- Utilized hospital morbidity database, administrative databases, and clinical records for patient data.
- Socioeconomic data were aggregated at the municipality of residence level.
Main Results:
- Only 18.8% of eligible patients (72% of total hospitalizations) were referred to cardiac rehabilitation.
- Females, older patients (55-64 years), and individuals from lower-income or lower-education municipalities had significantly lower referral rates.
- Attendance and dropout rates were also noted, indicating further barriers post-referral.
Conclusions:
- Significant sex, age, and socioeconomic disparities exist in cardiac rehabilitation referral after acute coronary syndrome.
- Current referral practices do not adequately reach disadvantaged patient groups.
- Development of targeted strategies is essential to promote equitable access to cardiac rehabilitation.
Objective:
The aim of the study is to identify factors associated with cardiac rehabilitation referral after an acute coronary syndrome at a university hospital.
Design:
We analyzed 2814 hospitalizations due to acute coronary syndrome between 2017 and 2019 in Centro Hospitalar São João. The hospital's morbidity database was used to retrieve patient information. Cardiac rehabilitation referral and participation were identified from administrative databases and clinical records. Socioeconomic data were obtained from municipality of residence-level data rather than patient-specific data.
Results:
Of 2814 hospitalizations, 72% (2028 cases) were eligible for cardiac rehabilitation. Mean age was 65.2 ± 13.4 yrs; 72% men, 33% diabetic, 57.1% hypertensive, and 63.6% dyslipidemic. Cardiac rehabilitation referral rate was low, at 18.8%, with 42 (11.0%) not attending cardiac rehabilitation and 39 (10.2%) dropping out. Females (odds ratio = 0.72 [95% confidence interval = 0.52-1.00]), older patients (odds ratio = 0.57 [0.42-0.77]; 55-64 vs. <55 yrs), and those coming from lower-income municipalities (odds ratio = 0.53 [0.41-0.69], below median vs. above median) with lower education level (odds ratio = 0.70 [0.54-0.92]; ≤4 vs. >4 yrs) were less likely to be referred to cardiac rehabilitation.
Conclusions:
There is a need for new strategies to promote cardiac rehabilitation in disadvantaged groups, as sex, age, and socioeconomic inequities in access to cardiac rehabilitation remain unresolved.
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