Cardiac rehabilitation barriers by rurality and socioeconomic status: a cross-sectional study

Abstract

IntroductionDespite greater need, rural inhabitants and individuals of low socioeconomic status (SES) are less likely to undertake cardiac rehabilitation (CR). This study examined barriers to enrollment and participation in CR among these under-represented groups.MethodCardiac inpatients from 11 hospitals across Ontario were approached to participate in a larger study. Rurality was assessed by asking participants whether they lived within a 30-minute drive-time from the nearest hospital, with those >30 minutes considered “rural.” Participants completed a sociodemographic survey, which included the MacArthur Scale of Subjective Social Status. One year later, they were mailed a survey which assessed CR utilization and included the Cardiac Rehabilitation Barriers Scale. In this cross-sectional study, CR utilization and barriers were compared by rurality and SES.ResultsOf the 1809 (80.4%) retained, there were 215 (11.9%) rural participants, and the mean subjective SES was 6.37 ± 1.76. The mean CRBS score was 2.03 ± 0.73. Rural inhabitants reported attending significantly fewer CR sessions (p < .05), and greater CR barriers overall compared to urban inhabitants (p < .01). Patients of lower subjective SES were significantly less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high SES counterparts (p < .01). Prominent barriers for both groups included distance, cost, and transportation problems. These relationships sustained adjustment, and a significant relationship between having undergone coronary artery bypass graft surgery and lower barriers was also identified.ConclusionsThe results confirm that rural inhabitants and patients of low SES experience greater barriers to CR utilization when compared to their urban, high SES counterparts. It is time to implement known strategies to overcome these barriers, to achieve equitable and greater use of CR.

Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation

“…9,23 In contrast to countries with rural areas, 23,30 the majority of our patients was living within a radius of 20 km of the CR center, making it unlikely that distance itself was a major issue. Because being dependent on transport and having no partner were key drivers in dropout, this suggests that a vulnerable social situation is more important than logistic barriers.…”

“…Despite the broad spectrum of included variables, some interesting variables are lacking such as information on illness cognition and perception and the influence of the income, which have been demonstrated to be important in literature. 9,12,14,23 Only 21% of the variation was explained, suggesting that other unknown factors are involved in this complex issue. The variation in the organization of CR across countries (eg, the number of sessions) may be a limitation for the generalization of our results.…”

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

“…14,[16][17][18][19]47 In fact, a significantly greater proportion of women than men are readmitted to hospital after CABG. 14,[17][18][19]47,48 Overall, the rate of readmissions have been reported to range between 12.9% and 16.5% within 30 days after surgery, [16][17][18][19] 24.1% within 3 months, 48 24.3% within 6 months, 14 and, among Medicare beneficiaries, 42% within 1 year of CABG surgery 15 and thus could affect both referral and CR wait times. Clearly, medical reasons for delayed entry are appropriate (however, it is arguable they could be mitigated by early follow-up in CR), and interventions are needed to focus on nonmedical reasons for delayed entry.…”

Subjective social status and health

“…Study populations range from representative samples of the USA and EU states [14][15][16][17], to large samples with civil servants from the UK and Brazil [10,18 & ,19], to children and adolescents [20 & , 21-23], to middle-aged and elderly populations [24][25][26][27][28][29], to ethnically diverse samples [8,30,31], to populations from developing countries [32][33][34][35], to immigrants [36][37][38], to pregnant women [39] and different clinical samples [40][41][42][43][44][45]. Findings from these studies indicate that lower SSS is related to several health indicators and risk factors for disease, including lower self-rated health, depressive symptoms, higher substance use, impaired sleep quality, functional decline, poor healthcare, food insecurity, poor oral health, biological risk factors, respiratory illness, reduced cardiovascular health, diabetes and mortality.…”