Graversen Christina Boesgaard, Eichhorst Regina, Ravn Lisbeth, Christiansen Susanne Svane Riis, Johansen Martin Berg, Larsen Mogens Lytken
a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark.
b Danish Centre against Inequality in Health (DACUS), Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark.
Scand Cardiovasc J. 2017 Dec;51(6):316-322. doi: 10.1080/14017431.2017.1385838. Epub 2017 Oct 11.
Barriers to participation in cardiac rehabilitation (CR) may occur at three levels of the referral process (lack of information, declining to participate, and referral to appropriate CR programme). The aim is to analyse the impact of socioeconomic status on barriers to CR and investigate whether such barriers influenced the choice of referral.
The Rehab-North Register, a cross-sectional study, enrolled 5455 patients hospitalised at Aalborg University Hospital with myocardial infarction (MI) during 2011-2014. Patients hospitalised with ST-elevated MI and complicated non-ST-elevated MI were to be sent to specialized CR, whereas patients with uncomplicated non-ST-elevated MI and unstable angina pectoris were to be sent to community-based CR. Detailed selected socioeconomic information was gathered from statistical registries in Statistics Denmark. Data was assessed using logistic regression.
Patients being retired, low educated, and/or with an annual gross income <27.000 Euro/yr were significantly less informed about cardiac rehabilitation programmes. Patients being older than 70 years, retired, low educated and/or with an annual gross income <27.000 Euro were significantly less willing to participate in CR. Further, this patient population were to a higher extent referred to community-based CR.
Patients with low socioeconomic status received less information about and were less willing to participate in cardiac rehabilitation. The same patient population was to a higher extent referred to community-based CR. Knowledge about barriers at different levels and the impact of social inequality may help in tailoring a better approach in the referral process to CR.
参与心脏康复（CR）的障碍可能出现在转诊过程的三个层面（信息缺乏、拒绝参与以及转诊至合适的CR项目）。目的是分析社会经济地位对CR障碍的影响，并调查此类障碍是否影响转诊选择。
“康复-北方登记册”是一项横断面研究，纳入了2011年至2014年期间在奥尔堡大学医院因心肌梗死（MI）住院的5455例患者。ST段抬高型MI和复杂非ST段抬高型MI住院患者应被转诊至专门的CR，而单纯性非ST段抬高型MI和不稳定型心绞痛患者应被转诊至社区CR。从丹麦统计局的统计登记处收集了详细的选定社会经济信息。使用逻辑回归评估数据。
退休、低学历和/或年总收入<27000欧元/年的患者对心脏康复项目的了解明显较少。70岁以上、退休、低学历和/或年总收入<27000欧元的患者参与CR的意愿明显较低。此外，这一患者群体被转诊至社区CR的比例更高。
社会经济地位较低的患者获得的心脏康复信息较少，参与意愿也较低。同一患者群体被转诊至社区CR的比例更高。了解不同层面的障碍以及社会不平等的影响可能有助于在转诊至CR的过程中制定更好的方法。
