Greater burden of risk factors and less effect of cardiac rehabilitation in elderly with low educational attainment: The Eu-CaRE study

I.E. Kjesbu*, N. Mikkelsen, K.L. Sibilitz, M. Wilhelm, C. Pena-Gil, V. Gonzalez-Salvado, M.C. Iliou, U. Zeymer, E.P. Meindersma, D. Ardissino, A.E. van der Velde, A.W.J. Van't Hof, E.P. de Kluiver, E. Prescott

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims

Socioeconomic status is a strong predictor of cardiovascular health. The aim of this study was to describe the immediate and long-term effects of cardiac rehabilitation (CR) across socioeconomic strata in elderly cardiac patients in Europe.

Methods and results

The observational EU-CaRE study is a prospective study with eight CR sites in seven European countries. Patients >= 65 years with coronary heart disease or heart valve surgery participating in CR were consecutively included. Data were obtained at baseline, end of CR and at one-year follow up. Educational level as a marker for socioeconomic status was divided into basic, intermediate and high. The primary endpoint was exercise capacity (peak oxygen consumption (VO2peak)). Secondary endpoints were cardiovascular risk factors, medical treatment and scores for depression, anxiety and quality of life (QoL). A total of 1626 patients were included; 28% had basic, 48% intermediate and 24% high education. A total of 1515 and 1448 patients were available for follow-up analyses at end of CR and one-year, respectively. Patients with basic education were older and more often female. At baseline we found a socioeconomic gradient in VO2peak, lifestyle-related cardiovascular risk factors, anxiety, depression and QoL. The socioeconomic gap in VO2peak increased following CR (p for interaction

Conclusions

We found a strong socioeconomic gradient in VO2peak and cardiovascular risk factors that was unaffected or worsened after CR. To address inequity in cardiovascular health, the individual adaption of CR according to socioeconomic needs should be considered.

Original languageEnglish
Article number2047487320921485
Pages (from-to)513-519
Number of pages7
JournalEuropean Journal of Preventive Cardiology
Volume28
Issue number5
Early online date27 Apr 2020
DOIs
Publication statusPublished - May 2021

Keywords

  • acute myocardial-infarction
  • anxiety
  • cardiac rehabilitation
  • cardiovascular prevention
  • coronary-heart-disease
  • depression
  • elderly
  • european association
  • position paper
  • prognosis
  • secondary prevention
  • social inequality
  • socioeconomic status
  • socioeconomic-status
  • EUROPEAN ASSOCIATION
  • SECONDARY PREVENTION
  • Cardiac rehabilitation
  • ACUTE MYOCARDIAL-INFARCTION
  • POSITION PAPER
  • DEPRESSION
  • CARDIOVASCULAR PREVENTION
  • ANXIETY
  • PROGNOSIS
  • CORONARY-HEART-DISEASE
  • SOCIOECONOMIC-STATUS

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