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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Social Inequality in the Comprehensive Cardiac Rehabilitation Pathway: A Nationwide Cohort Study Across Hospitals and
Marie Louise Svendsen1, Jens Refsgaard, Mette Bredsgaard
1Author Affiliations: DEFACTUM, Central Denmark Region, Aarhus, Denmark (Dr Svendsen and Dr Maribo); Regional Hospital Viborg, Viborg, Denmark (Dr Refsgaard); The Health Centre of Viborg Municipality, Viborg, Denmark (RN Bredsgaard); and Department of Public Health, Aarhus University, Aarhus, Denmark (Dr Maribo).
Insights
Socioeconomic status significantly impacts cardiac rehabilitation (CR) access and completion. Lower socioeconomic positions face higher risks of delayed needs assessment and reduced participation in CR components, highlighting disparities in cardiovascular care.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiac rehabilitation (CR) is crucial for ischemic heart disease (IHD) recovery.
- Nonpharmacological CR pathways involve multiple components from hospital discharge to completion.
- Socioeconomic factors may influence access and engagement in CR.
Purpose of the Study:
- To examine socioeconomic differences in the nonpharmacological cardiac rehabilitation (CR) pathway.
- To identify disparities from hospital discharge to CR completion in hospital and primary care settings.
Main Methods:
- Nationwide cohort study of 45,497 patients hospitalized with IHD (2019-2022).
- Analysis of nonutilization of 11 CR components, including delayed needs assessment and exercise training.
- Socioeconomic status assessed by education, income, occupation, and cohabitant status.
Main Results:
- Only 43% of IHD patients participated in CR; 25% received timely needs assessment.
- Significant socioeconomic differences observed in CR pathway, except for finalizing meeting, CRF improvement, and smoking cessation.
- Lower educational attainment associated with 8% higher odds of delayed CR needs assessment and 31% higher odds of no cardiorespiratory fitness (CRF) test.
Conclusions:
- Socioeconomic disparities exist throughout the CR pathway.
- Targeted interventions are needed to ensure equitable CR needs assessment and participation.
- Specific patient characteristics and CR activities are key to reducing inequalities in cardiovascular rehabilitation.
Purpose:
To examine socioeconomic differences in the nonpharmacological cardiac rehabilitation (CR) pathway from hospital discharge to CR completion in hospital and primary care settings.
Methods:
This nationwide cohort study included patients hospitalized with ischemic heart disease between April 1, 2019, and March 31, 2022. Follow-up continued through December 31, 2022, focusing on nonutilization of 11 CR components, including: delayed CR needs assessment (>14 days) and physical exercise training (>29 days); lack of patient education, physical exercise training, test of cardiorespiratory fitness (CRF), depression screening, improvement in CRF (<10% increase), smoking cessation, and finalizing CR meeting; and completion of <75% of planned exercise sessions and dropout. Socioeconomic differences were analyzed by educational attainment, income, occupation, and cohabitant status.
Results:
Among 45 497 hospitalized patients with ischemic heart disease, 43% (n = 19 573) participated in CR. Only 25% received a CR needs assessment within 14 days of discharge. Socioeconomic differences were demonstrated throughout the CR pathway, except for the finalizing meeting, improvement in CRF, and smoking cessation. The odds of nonutilization among patients with lower educational attainment ranged between 8% higher odds of delayed CR needs assessment (adjusted OR = 1.08: 95% CI, 1.01-1.15) and 31% higher odds of no CRF test (adjusted OR = 1.31: 95% CI, 1.18-1.45).
Conclusions:
The observed socioeconomic differences throughout the CR pathway underscore the need for targeted interventions to ensure early assessment of CR needs and participation in specific CR activities among patients with lower socioeconomic positions. This study identifies specific patient characteristics and CR activities as key markers for reducing these inequalities.
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