Association Of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?

Introduction: Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR. Methods: We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation. Results: In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p<0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p<0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p<0.01) and mortality (p<0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group. Discussion: We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.