Association between socioeconomic characteristics among individuals who completed cardiac rehabilitation in low‐resource settings with their depressive symptoms and quality of life: analysis from the ICRR

Background:
Cardiac rehabilitation supports recovery after cardiac events, but it is unclear whether outcomes differ by socioeconomic characteristics in low‐resource settings. This study aimed to identify whether pre‐program socioeconomic characteristics (financial strain, age, education, employment) were associated with cardiac rehabilitation completion, and–among completers–to examine associations with changes in depressive symptoms and quality of life from pre‐ to post‐program.

Methods:
Individuals with pre‐program data (2021‐May 2024) in the ICRR (International Cardiac Rehab Registry), from 17 programs in low‐resource settings across 11 countries, were included. Outcomes were changes in Patient Health Questionnaire‐2 depressive symptoms and Cantril's Ladder quality of life scores. Among completers, associations were examined using robust linear mixed‐effects models, adjusting for characteristics, with a random intercept for site.

Results:
Among 3520 individuals (mean age 59 years [SD=12], 79% men), 2190 (62%) completed cardiac rehabilitation. Completion was more common among those without financial strain (20% versus 10%, P<0.001), with >12 years of education (57% versus 44%, P<0.001), and employed (40% versus 20%, P<0.001). Among completers, median depressive symptoms improved from 1 (interquartile range=2) to 0 (interquartile range=0), and quality of life from 8 (interquartile range=2) to 10 (interquartile range=2). Reporting financial strain as “often” was associated with greater improvement in depressive symptoms (β=−0.337, 95% CI=−0.534, −0.140, P=0.021), while employment was associated with smaller improvement (β=0.297, 95% CI=0.104, 0.489, P=0.019). Age and education were not associated with change in depressive symptoms. No socioeconomic characteristics were associated with change in quality of life.

Conclusions:
These findings suggest socioeconomic pressures are associated with differences in recovery. Flexible cardiac rehabilitation models may support individuals in low‐resource settings.