Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort

Abstract

ObjectivesTo estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions.DesignProspective cohort study.SettingPatients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months.ParticipantsBetween August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up.Outcome measuresReferral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians.ResultsPatients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers.ConclusionsCR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.

Barriers to Participation in Cardiac Rehabilitation Among Patients with Coronary Heart Disease After Reperfusion Therapy: A Scoping Review

“…However, in the participation level section, the authors divide the participation rate into three categories they are low respondents participation in CR (≤50%), moderate (51–75%), and high (>75%) (see Table 2 ). Based on the categorization of participation rates in CR, it shows that most of the studies analyzed show a low participation rate (n=12), 10 , 13 , 23 , 26–28 , 34 , 35 , 38 , 39 , 41 , 43 moderate participation rate (n=7), 7 , 11 , 16 , 33 , 36 , 37 , 42 and a high participation rate CR (n=4). 9 , 19 , 22 , 40 …”

“…Based on the categorization of participation rates in CR, it shows that most of the studies analyzed show a low participation rate (n=12), 10 , 13 , 23 , 26–28 , 34 , 35 , 38 , 39 , 41 , 43 moderate participation rate (n=7), 7 , 11 , 16 , 33 , 36 , 37 , 42 and a high participation rate CR (n=4). 9 , 19 , 22 , 40 …”

“…Furthermore, most CR program types undertaken by participants from the studies were carried out in hospitals 7 , 9–11 , 13 , 16 , 19 , 23 , 26–28 , 33 , 37–43 and only the study by Cao et al, 2021 which report home and exercise-based CR with most of the participants had a moderate participation rate (64.66%). 36 Furthermore, two studies did not mention the type of CR program.…”

“…Travel time exceeding the recommended average (<30 minutes) was reported as the most significant barrier to CR program participation in various countries. 10 , 22 , 26 , 28 , 33 , 37 , 40 The location of CR facilities, generally in the centre of big cities, makes reaching difficult, especially for patients from rural areas. 10 , 21 , 37 This is supported by previous findings, which state that CR program patients have a shorter travel time than patients who do not participate.…”

“… 10 , 22 , 26 , 28 , 33 , 37 , 40 The location of CR facilities, generally in the centre of big cities, makes reaching difficult, especially for patients from rural areas. 10 , 21 , 37 This is supported by previous findings, which state that CR program patients have a shorter travel time than patients who do not participate. 33 The most frequent CR barriers were the distance from the hospital/rehabilitation centre, travel costs, and lack of information about the CR program.…”