Socio-geographical factors associated with cardiac rehabilitation participation after percutaneous coronary intervention: a registry-based cohort study from France

Cardiac rehabilitation (CR) after percutaneous coronary intervention (PCI) for acute (ACS) or chronic (CCS) coronary syndrome is underutilized worldwide. The determinants of underuse are not fully understood. Using real-world data, this study explored the effect of socio-geographical factors on CR participation.

Patients from the Aquitaine region (France) who underwent PCI between 2017 and 2019 were selected from a regional PCI register. Their 1-year CR participation was tracked using the French hospital database. Associations between CR participation and socio-geographical factors (social deprivation, general practitioner accessibility, and distance to the nearest CR centre) were assessed through logistic regression mixed models at 1 and 3 months in ACS, and at 3 and 6 months in CCS. Among the 19 002 patients, 5073 (26.7%) participated in CR (ACS: 4071, 33.0%; CCS: 1002, 15.0%). A CR centre distance >25 km reduced participation at 3 months in ACS patients [odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.70–0.99, P = 0023] but not at 1 month after PCI. Chronic coronary syndrome patients from most advantaged areas were more likely to participate in CR at 3 (OR = 0.62, 95% CI: 0.44–0.88, P = 0.002) and 6 months (OR = 0.59, 95% CI: 0.42–0.82, P < 0.001). General practitioner accessibility did not affect participation.

Post-PCI CR participation was low. Proximity to CR centres promoted participation for ACS patients, while CR usage correlated with higher socioeconomic status for CCS patients. These findings highlight socio-geographical inequalities in CR access, providing a basis for targeted interventions, such as telerehabilitation or expanded coverage.