Socioeconomic variation in the relationship between cardiac rehabilitation participation and clinical outcomes: a systematic review

AIM: To systematically evaluate whether relationships between cardiac rehabilitation participation and clinical outcomes, return to work, or knowledge about cardiovascular disease vary across socioeconomic indicators.

METHODS: A systematic review was conducted using CENTRAL, CINAHL, Embase and Medline up to 1 November 2024. Studies were included if they compared outcomes between participants who received cardiac rehabilitation and those who did not or received an exercise programme. Outcomes included all-cause death, all-cause and cardiovascular-related rehospitalisation, return to work and cardiovascular knowledge, stratified by socioeconomic indicators. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies-of Interventions-I tool.

RESULTS: Six studies involving 555 731 participants were included. Compared with non-participants, cardiac rehabilitation participants had lower rates of all-cause death (12.3%-16.9%) and all-cause rehospitalisation (15.2%-16.1%), with incidence rate differences in cardiovascular-related rehospitalisation reaching up to 27.8 fewer events/100 person-years. Some of the greatest differences were among participants residing in more disadvantaged areas, although this was not consistent across studies. No significant differences were observed in the combined outcome of all-cause death and cardiovascular-related rehospitalisation when stratified by educational attainment levels. Return to work and knowledge outcomes showed greater variation across education and income subgroups, with higher values consistently observed among cardiac rehabilitation participants from less disadvantaged backgrounds. All studies were observational and had moderate risk of bias.

CONCLUSIONS: Cardiac rehabilitation improves clinical and functional outcomes across socioeconomic subgroups, although disparities in participation and outcomes persist. Tailoring programme delivery to be more flexible and responsive to literacy needs may help ensure its benefits are equitably achieved across patient subgroups.

PROSPERO REGISTRATION NUMBER: CRD42022332355.