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Graversen, Christina Boesgaard; Johansen, Martin Berg; Eichhorst, Regina; Johnsen, Søren Paaske; Riahi, Sam; Holmberg, Teresa; Larsen, Mogens Lytken

Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study

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  • Media type: E-Article
  • Title: Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study
  • Contributor: Graversen, Christina Boesgaard; Johansen, Martin Berg; Eichhorst, Regina; Johnsen, Søren Paaske; Riahi, Sam; Holmberg, Teresa; Larsen, Mogens Lytken
  • imprint: BMJ, 2020
  • Published in: BMJ Open
  • Language: English
  • DOI: 10.1136/bmjopen-2019-036088
  • ISSN: 2044-6055
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the association between socioeconomic status (SES) and referral to cardiac rehabilitation (CR) after incident acute coronary syndrome (ACS) by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate in CR, (3) and assigned CR setting.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Department of Cardiology at a Danish University Hospital from 1 January 2011 to 31 December 2014.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>A total of 1229 patients assessed for CR during hospitalisation with ACS were prospectively registered in the Rehab-North Register from 2011 to 2014. SES was assessed using data from national registers, concerning: personal income, occupational status, educational level and civil status. Patients were excluded if one of the following criteria was fulfilled: (1) missing data on SES, or (2) acceptable reason for not informing patients about CR (treatment with coronary artery bypass grafting, transfer to another hospital, still under treatment or death).</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Outcomes were defined by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate, and (3) assigned CR setting (in-hospital/community centre) after ACS.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 854 (69.5 %) patients were referred to CR. After adjustment for age, gender, ACS diagnosis (ST-elevated myocardial infarction, non-ST-elevated myocardial infarction, unstable angina pectoris) and comorbidity, high income had the strongest association of referral to CR in all three phases (informed about CR: OR 2.17, 95% CI 1.01 to 4.64; willingness to participate in CR: OR 1.55, 95% CI 1.02 to 2.35; assigned in-hospital CR: OR 1.47, 95% CI 0.91 to 2.36). Educational level showed similar tendencies, however not statistically significant. The results did not vary according to gender.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This is the first study to investigate the referral process to CR using a three-phase structure. It suggests income and education to influence all phases in the referral process to CR after ACS.</jats:p></jats:sec>
  • Access State: Open Access