Socioeconomic Variation in the Association Between Participation in Cardiac Rehabilitation and Clinical Outcomes in Patients With Acute Coronary Syndrome

Purpose:
To investigate (1) the relationship between socioeconomic status of patients with acute coronary syndrome and participation in cardiac rehabilitation and (2) the relationship between patient participation stratified by socioeconomic status and their outcomes at 12 months.

Methods:
Analyzed data were from the CONCORDANCE registry. Patients were stratified (quintiles) according to the National Index of Relative Socio-Economic Disadvantage. The odds of a major adverse cardiovascular event (MACE; defined as heart failure, myocardial infarction, stroke, or cardiac-cause death) and separately all-cause death between hospital discharge and 12 months were analyzed using multilevel logistic regression models, adjusting for clinical history and hospital clustering.

Results:
Of 3787 patients referred to cardiac rehabilitation, followed up at 6 and 12 months, 1834 (48%) participated in cardiac rehabilitation. Participation rate was higher among patients in least socioeconomically disadvantaged quintiles (Q5 [least disadvantaged]: 61%, Q4: 53%, Q3: 42%, Q2: 47%, Q1 [most disadvantaged]: 42%). The odds of MACE were not different between participants and non-participants (6% vs 8%, OR = 0.87: 95% CI, 0.66-1.15). However, the odds of death were lower among participants than non-participants (0.4% vs 2%, OR = 0.35: 95% CI, 0.16-0.78). The association between participation and MACE and death did not differ by socioeconomic status (Pinteraction = .6943 and Pinteraction = .6339, respectively).

Conclusions:
Although patient socioeconomic status may influence their participation rates in cardiac rehabilitation, no significant differences were observed in the relationships between participation and MACE or mortality at 12 months across socioeconomic groups. Targeted strategies are needed to improve participation rates across all socioeconomic groups.