Journal of the American Heart Association · 2026
Association Between Socioeconomic Characteristics Among Individuals Who Completed Cardiac Rehabilitation in Low-Resource Settings With Their Depressive Symptoms and Quality of Life: Analysis From the ICRR.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Manandi Deborah, Turk-Adawi Karam, Candelaria Dion, Zende Anjali, Jiandani Mariya, Ka Mame Madjiguene, Chen Ssu-Yuan, Cuenza Lucky, Redfern Julie, Hyun Karice, ICRR investigators
Аннотация
BACKGROUND: Cardiac rehabilitation supports recovery after cardiac events, but it is unclear whether outcomes differ by socioeconomic characteristics in low-resource settings. This study aimed to identify whether pre-program socioeconomic characteristics (financial strain, age, education, employment) were associated with cardiac rehabilitation completion, and-among completers-to examine associations with changes in depressive symptoms and quality of life from pre- to post-program.
METHODS: Individuals with pre-program data (2021-May 2024) in the ICRR (International Cardiac Rehab Registry), from 17 programs in low-resource settings across 11 countries, were included. Outcomes were changes in Patient Health Questionnaire-2 depressive symptoms and Cantril's Ladder quality of life scores. Among completers, associations were examined using robust linear mixed-effects models, adjusting for characteristics, with a random intercept for site.
RESULTS: Among 3520 individuals (mean age 59 years [SD=12], 79% men), 2190 (62%) completed cardiac rehabilitation. Completion was more common among those without financial strain (20% versus 10%, P<0.001), with >12 years of education (57% versus 44%, P<0.001), and employed (40% versus 20%, P<0.001). Among completers, median depressive symptoms improved from 1 (interquartile range=2) to 0 (interquartile range=0), and quality of life from 8 (interquartile range=2) to 10 (interquartile range=2). Reporting financial strain as "often" was associated with greater improvement in depressive symptoms (β=-0.337, 95% CI=-0.534, -0.140, P=0.021), while employment was associated with smaller improvement (β=0.297, 95% CI=0.104, 0.489, P=0.019). Age and education were not associated with change in depressive symptoms. No socioeconomic characteristics were associated with change in quality of life.
CONCLUSIONS: These findings suggest socioeconomic pressures are associated with differences in recovery. Flexible cardiac rehabilitation models may support individuals in low-resource settings.
METHODS: Individuals with pre-program data (2021-May 2024) in the ICRR (International Cardiac Rehab Registry), from 17 programs in low-resource settings across 11 countries, were included. Outcomes were changes in Patient Health Questionnaire-2 depressive symptoms and Cantril's Ladder quality of life scores. Among completers, associations were examined using robust linear mixed-effects models, adjusting for characteristics, with a random intercept for site.
RESULTS: Among 3520 individuals (mean age 59 years [SD=12], 79% men), 2190 (62%) completed cardiac rehabilitation. Completion was more common among those without financial strain (20% versus 10%, P<0.001), with >12 years of education (57% versus 44%, P<0.001), and employed (40% versus 20%, P<0.001). Among completers, median depressive symptoms improved from 1 (interquartile range=2) to 0 (interquartile range=0), and quality of life from 8 (interquartile range=2) to 10 (interquartile range=2). Reporting financial strain as "often" was associated with greater improvement in depressive symptoms (β=-0.337, 95% CI=-0.534, -0.140, P=0.021), while employment was associated with smaller improvement (β=0.297, 95% CI=0.104, 0.489, P=0.019). Age and education were not associated with change in depressive symptoms. No socioeconomic characteristics were associated with change in quality of life.
CONCLUSIONS: These findings suggest socioeconomic pressures are associated with differences in recovery. Flexible cardiac rehabilitation models may support individuals in low-resource settings.