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Long-term follow-up on socially differentiated cardiac rehabilitation and depression: How do socially vulnerable cardiac patients apply health care services?

Session Poster session 1

Speaker Kathrine Hald

Event : EuroHeartCare 2018

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

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

Authors:
K Hald1 , LK Meillier2 , KM Nielsen3 , FB Larsen2 , MB Johansen4 , ML Larsen5 , CV Nielsen1 , B Christensen6 , 1Section of clinical social medicine and rehabilitation, Department of public health, Aarhus University - Aarhus - Denmark , 2DEFACTUM, Social and health services and labour market, Central Denmark Region - Aarhus - Denmark , 3Department of cardiology, Aarhus University Hospital - Aarhus - Denmark , 4Department of cardiology, Aalborg University Hospital - Aalborg - Denmark , 5Danish centre for inequality in health, Department of cardiology, Aalborg University Hospital - Aalborg - Denmark , 6Section for general medical practice, Department of public health, Aarhus University - Aarhus - Denmark ,

Citation:
European Journal of Cardiovascular Nursing ( 2017 ) 17 ( Supplement ), S50

Background: Cardiovascular disease is the leading cause of morbidity and mortality in Europe. Cardiac rehabilitation (CR) is highly effective in secondary cardiovascular disease prevention. Depression is a common condition post myocardial infarction (MI) and 20 % of patients with first-episode MI will experience depression in the first two years after admission. CR reduces depression in patients with MI, but it is known that socially vulnerable patients are more depressed than non-socially vulnerable patients. Whereas CR decreases the risk of hospital admissions, readmissions and in-patient days, depression is associated with a greater probability of readmissions, the number of in-patient days and contacts to general practice. These associations are also seen regarding social vulnerability. However a study found that MI-patients who are depressed, who have a low educational level or who are living alone have fewer contacts to general practice and hospital in the first two years after admission. A CR-intervention focusing on minimizing social inequalities in health was carried out from 2000-2004. An intervention group of socially vulnerable patients received a socially differentiated CR-intervention and were compared to a group of socially vulnerable patients who received standard care. The intervention showed significant results regarding adherence to secondary prevention guidelines at one-year follow-up. However no long-term effects were seen regarding morbidity and mortality at 10-year follow-up.
Purpose: Based on the non-significant long-term effects of the intervention and the inconclusive evidence on the association between social vulnerability, depression and the use of health care services, the aim of the present study is to investigate the long-term effects of a socially differentiated CR-intervention regarding use of health care services in a socially vulnerable population of patients diagnosed with MI with a focus on post-MI depression.
Methods: The study will be conducted as a prospective register based cohort study. The study population consists of 379 patients admitted with first-episode MI and who participated in a socially differentiated CR-intervention or received standard care at a university hospital in Denmark from 2000-2004. At a 10-year follow-up the outcomes of interest are:
All-cause hospitalizations
Cardiovascular readmissions
All-cause visits in general practice
Participation in yearly chronic care controls in general practice
The impact of post-MI depression
Expected results: The hypothesis is that socially vulnerable patients who participated in the socially differentiated intervention will have a lower prevalence of post-MI depression and show different patterns in their use of health care services when compared to socially vulnerable patients who received standard care.
Conclusion: The analyses of the study are conducted in February 2018 and will be presented at Euro Heart Care in June 2018.

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