Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark.
Centre for Clinical Research and Disease Prevention, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark.
PLoS One. 2022 Nov 7;17(11):e0276768. doi: 10.1371/journal.pone.0276768. eCollection 2022.
Cardiovascular patients with low socioeconomic status and non-western ethnic background have worse prognostic outcomes. The aim of this nationwide study was first to address whether short-term effects of hospital-based outpatient cardiac rehabilitation (CR) are similar across educational level and ethnic background, and secondly to study whether known disparity in long-term prognosis in patients with cardiovascular disese is diminished by CR participation.
All patients with myocardial infarction and/or coronary revascularization from August 2015 until March 2018 in the Danish national patient registry or the Danish cardiac rehabilitation database (DHRD) were included. We used descriptive statistics to address disparity in achievement of quality indicators in CR, and Cox proportional hazard regression to examine the association between the disparity measures and MACE (cardiovascular hospitalization and all-cause mortality) with adjustment for age, gender, index-diagnose and co-morbidity.
We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR outcomes from the DHRD. We demonstrated a socioeconomic gradient in improvements in VO2peak, and non-western patients were less often screened for depression or receive dietary consulting. We found a strong socioeconomic gradient in MACE irrespective of CR participation, medication, and risk factor control (adjusted HR 0.65 (95% CI 0.56-0.77) for high versus low education). Non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1-1.4)).
We found only minor socioeconomic and ethnic differences in achievement of CR quality indicators but strong differences in CHD prognosis indication that conventional risk factor control and medical treatment following CR do not diminish the socioeconomic and ethnical disparity in CHD prognosis.
心血管病患者社会经济地位低和非西方族裔背景与预后不良相关。本项全国性研究旨在首先探讨基于医院的门诊心脏康复（CR）短期疗效是否因教育水平和种族背景而异，其次探讨心脏康复是否可降低心血管疾病患者长期预后的差异。
纳入 2015 年 8 月至 2018 年 3 月期间丹麦国家患者登记处或丹麦心脏康复数据库（DHRD）中所有心肌梗死和/或冠状动脉血运重建的患者。我们使用描述性统计来探讨 CR 质量指标的达标情况差异，并使用 Cox 比例风险回归来评估差异指标与 MACE（心血管住院和全因死亡率）的相关性，调整年龄、性别、指数诊断和合并症。
共纳入 34511 例患者，其中 19383 例患者参加了 CR，9882 例患者从 DHRD 中提供了 CR 结果的信息。我们发现 VO2peak 改善方面存在社会经济梯度，且非西方患者较少接受抑郁筛查或饮食咨询。无论是否参加 CR、使用药物和控制风险因素，我们均发现 MACE 存在强烈的社会经济梯度（校正 HR 0.65（95%CI 0.56-0.77），高教育程度与低教育程度相比）。非西方起源与 MACE 风险增加相关（校正 HR 1.2（1.1-1.4））。
我们发现 CR 质量指标的达标情况仅存在较小的社会经济和种族差异，但 CHD 预后存在显著差异，这表明常规的风险因素控制和 CR 后的药物治疗并不能缩小 CHD 预后的社会经济和种族差异。
