Abstract P653: Cardiac Rehabilitation Participation is Associated With Lower Risk of Major Adverse Cardiovascular Events Across Race or Ethnicity and Income

Abstract

Introduction: Cardiac rehabilitation (CR) participation reduces the likelihood of major adverse cardiovascular events (MACE), but is limited by structural factors, including race or ethnicity and annual income. We investigated (1) associations between CR participation and MACE, and (2) how structural disadvantage modifies this association, focusing on the intersection between race or ethnicity and household income. Hypotheses: We hypothesized that (1) CR participation would be inversely associated with MACE, and (2) this association would attenuate differences in MACE by race or ethnicity, as well as by household income. Methods: We identified 212,744 individuals with a CR-qualifying event between 1/1/16 and 12/31/20 in Optum’s de-identified Clinformatics® Data Mart database. We evaluated associations between CR sessions attended (0 to 36) and MACE (cardiac arrest, heart failure, myocardial infarction, or stroke hospitalizations) using a proportional hazards model for recurrent events, and assessed the three-way interaction between CR participation, race or ethnicity, and household income. Results: We included 212,744 individuals (age 70.8±11.3 years; 37.8% female sex; 71.9% White race) of whom 26.0% attended ≥1 CR sessions. Overall, we observed a dose-response association between CR participation and MACE. After adjustment, those who did not attend CR were 2.9 times as likely to experience MACE as those who attended ≥36 sessions (95% CI: 2.71, 3.03, P <0.0001), for whom there were no significant differences by race or ethnicity ( Figure ). Associations between CR participation and MACE were similar both across race or ethnicity and by household income ( P , interaction=0.28). Conclusion: Greater CR participation is associated with lower risk of MACE, regardless of (1) race or ethnicity and (2) household income. Because participation in CR remains low, particularly in socially disadvantaged populations, interventions to promote use of CR are critical to reduce disparities in cardiovascular outcomes.