Larner College of Medicine at the University of Vermont, Burlington (Drs Gaalema, O'Neill, and Bolívar and Ms Denkmann); Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington (Mr Savage and Drs Khadanga and Ades); and Department of Biostatistics, University of Vermont, Burlington (Dr Priest).
J Cardiopulm Rehabil Prev. 2022 Jul 1;42(4):227-234. doi: 10.1097/HCR.0000000000000646. Epub 2021 Nov 24.
Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR.
This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ 2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate.
Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables.
Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.
心脏病发作后参加心脏康复（CR）可带来许多临床益处。社会经济地位（SES）较低的患者参加 CR 的可能性较低。尚不清楚他们是否获得了与 SES 较高的患者相似的临床益处。本研究探讨了教育程度（SES 的一种衡量标准）如何预测 CR 过程中的依从性和改善情况。
这是一项前瞻性观察性研究，纳入了 2016 年 1 月至 2019 年 12 月期间在位于佛蒙特州伯灵顿的 CR 计划中登记的 1407 例患者。在进入 CR 时和对其中一部分（n = 917）在退出 CR 时获得了教育年限、吸烟状况（自我报告和客观测量）、抑郁症状水平（患者健康问卷）、自我报告的身体功能（医疗结果调查）、健康水平（峰值代谢当量、峰值摄氧量和握力）和身体成分（体重指数和腰围）。使用 Kruskal-Wallis 或 Pearson's χ 2 检验（视情况而定）来检查教育程度与基线特征的相关性。使用协方差分析或逻辑回归（视情况而定）来检查教育程度与 CR 期间改善的相关性。
教育程度与在进入 CR 时检查的大多数患者特征显著相关，并且是完成 CR 课程数量的重要预测因素。较低的教育程度与心肺健康的改善程度较低有关，即使在控制了其他变量后也是如此。
SES 较低的患者参加 CR 的次数少于 SES 较高的患者，并且可能无法从参加中获得相同的益处。计划需要增加该人群的出勤率，并考虑对计划进行修改，以进一步支持 CR 期间的行为改变。
