Socioeconomic Inequalities and Predictors of Cardiac Rehabilitation Referral: Real-World Evidence.

Objective The aim of the study is to identify factors associated with cardiac rehabilitation referral after an acute coronary syndrome at a university hospital.Design We analyzed 2814 hospitalizations due to acute coronary syndrome between 2017 and 2019 in Centro Hospitalar Sao Joao. The hospital's morbidity database was used to retrieve patient information. Cardiac rehabilitation referral and participation were identified from administrative databases and clinical records. Socioeconomic data were obtained from municipality of residence-level data rather than patient-specific data.Results Of 2814 hospitalizations, 72% (2028 cases) were eligible for cardiac rehabilitation. Mean age was 65.2 +/- 13.4 yrs; 72% men, 33% diabetic, 57.1% hypertensive, and 63.6% dyslipidemic. Cardiac rehabilitation referral rate was low, at 18.8%, with 42 (11.0%) not attending cardiac rehabilitation and 39 (10.2%) dropping out. Females (odds ratio = 0.72 [95% confidence interval = 0.52-1.00]), older patients (odds ratio = 0.57 [0.42-0.77]; 55-64 vs. <55 yrs), and those coming from lower-income municipalities (odds ratio = 0.53 [0.41-0.69], below median vs. above median) with lower education level (odds ratio = 0.70 [0.54-0.92]; <= 4 vs. >4 yrs) were less likely to be referred to cardiac rehabilitation.Conclusions There is a need for new strategies to promote cardiac rehabilitation in disadvantaged groups, as sex, age, and socioeconomic inequities in access to cardiac rehabilitation remain unresolved.