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Long term follow-up on socially differentiated cardiac rehabilitation

Session Poster session 4

Speaker Kathrine Hald

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : K Hald (Aarhus C,DK), KM Nielsen (Aarhus N,DK), LK Meillier (Aarhus N,DK), FB Larsen (Aarhus N,DK), B Christensen (Aarhus C,DK), CV Nielsen (Aarhus C,DK), ML Larsen (Aalborg,DK)

K. Hald1 , K.M. Nielsen2 , L.K. Meillier3 , F.B. Larsen3 , B. Christensen4 , C.V. Nielsen1 , M.L. Larsen5 , 1Section of Clinical Social Medicine and Rehabilitation, Central Denmark Region, Department of Public Health, Aarhus University - Aarhus C - Denmark , 2Institute of Clinical Medicine, Aarhus University Hospital - Aarhus N - Denmark , 3Central Denmark Region - Aarhus N - Denmark , 4Section of General Medicine, Department of Public Health, Aarhus University - Aarhus C - Denmark , 5Department of Cardiology, Aalborg University Hospital - Aalborg - Denmark ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 717-718

Background: Cardiac rehabilitation (CR) has a positive influence on cardiovascular risk factors. It reduces disabilities, increases the quality of life and lowers the likelihood of fatal and non-fatal events. However, socially vulnerable patients do not achieve the same effect. A research project performed at a university hospital in Denmark from 2000–2004, offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and BMI, when compared to socially vulnerable patients who received standard CR.

Aim: The aim of the study was to perform a long term follow-up on a socially differentiated CR intervention and examine the effect of the intervention regarding fatal and non-fatal endpoints.

Methods: A population of 208 socially vulnerable patients <70 years old who were admitted with first-incidence MI at a university hospital, participated in a socially differentiated CR intervention. The patients were considered to be socially vulnerable if they had low education and / or lived without a partner. From 2000–2002 the patients who were admitted recieved standard CR according to international og national guidelines. From 2002–2004 the patients who were admitted recieved an expanded intervention, which consisted of standard CR and additional offers such as more consultations and a better phase III handover to general practice.

Results: The study was based on Danish register data and a follow-up on a 100% was achieved. There was no significant difference in the fatal and non-fatal endpoints measured at ten-year follow-up when comparing the expanded CR intervention to standard CR. When adjusting for gender and age, diabetes status and smoking status at baseline a non-significant association was still seen.

Conclusion: Despite the significant results of the expanded CR intervention measured at one-year follow-up no long-term effects were seen regarding fatal and non-fatal endpoints. Future research will examine the long term effects on the patients' adherence to secondary prevention and their use of health services, with a focus on the importance of phase III maintenance.

Results of the unadjusted and adjusted analyses of the 10-year follow-up of a socially differentiated CR intervention
Crude OR (95% CI)P-valueAdjusted OR (95% CI)P-value
All-cause mortality1.18 (0.55; 2.53)0.681.29 (0.58; 2.89)0.53
Cardiovascular mortality0.81 (0.31; 2.11)0.660.80 (0.31; 2.09)0.65
Non-fatal recurrent events1.57 (0.65; 3.76)0.311.62 (0.66; 3.92)0.29
MACE1.03 (0.49; 2.15)0.941.13 (0.53; 2.42)0.75
Ten-year Kaplan Meier survival analyses

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