Abstract 14518: Social Determinants of Health Impact Cardiac Rehabilitation Referral and Participation Patterns Among Patients With Coronary Heart Disease

Abstract

Introduction: Cardiac Rehabilitation (CR) is a medically supervised preventative cardiovascular program recommended following cardiovascular illnesses. Although the benefits of CR are well-studied and participation considered a Class Ia recommendation, referral and participation rates are low. Hypothesis: We hypothesized socioeconomic factors negatively impact participation and referral patterns among individuals with CHD. Methods: Our prospective study included 561 patients hospitalized with ACS to University of California San Diego Medical Centers in Southern California. Participants included adult patients 18 years or older from rural and urban communities admitted for percutaneous coronary intervention, coronary artery bypass grafting, or acute myocardial infarction. Baseline characteristics were compared by paired t-tests and chi-square analysis for continuous and categorical variables, respectively. Univariable and multivariable logistic regression models were utilized to assess the impact socioeconomic factors have on CR referral and participation patterns. Results: Of the 561 enrolled participants, 317 were referred to CR. Income, language, and urban/rural setting were found to be statistically significant in the univariate and multivariate analysis with those with incomes above 60 K/year being 1.73 times more likely to be referred than those with income <30K/year (95% CI 1.00-2.99), English speakers 3.53 times more likely to be referred than Spanish speakers (95% CI 1.83-6.94), and those in urban settings 2.12 times more likely to be referred than those in rural settings (95% CI 1.29-3.50). Among the 317 referred patients, 75.4% participated in at least one CR session. In those referred, after adjusting for cofounding factors, language and city setting were the most significant factors impacting participation, with English speakers being 3.8 times more likely to participate than Spanish speakers (95% CI 1.28-11.99), and those living in urban setting being 2.33 times more likely to participate than those living in rural areas (95% CI 1.00-5.37). Conclusions: The identification of significant socioeconomic factors can help implement institutional initiatives that eliminate the disparities identified.