Lower educational attainment, unemployment, and non-Western ethnicity were associated with lower peak oxygen uptake before cardiac rehabilitation and less improvement following it.
Cohort (n=1,217)
Do depression, socioeconomic factors, and ethnicity predict cardiorespiratory fitness before and after cardiac rehabilitation in patients with heart disease?
Socioeconomic factors and ethnicity, but not depression, are significant predictors of baseline cardiorespiratory fitness and its improvement following cardiac rehabilitation, highlighting the need for tailored programs for vulnerable subgroups.
PURPOSE: To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake ((Equation is included in full-text article.)O2peak) and whether these factors modify the effect of cardiac rehabilitation (CR). METHODS: A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR. (Equation is included in full-text article.)O2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients. RESULTS: Mean ± SD (Equation is included in full-text article.)O2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower (Equation is included in full-text article.)O2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of (Equation is included in full-text article.)O2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of (Equation is included in full-text article.)O2peak while depression was not. CONCLUSION: Education, attachment to the workforce, and ethnicity were all associated with lower (Equation is included in full-text article.)O2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence (Equation is included in full-text article.)O2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.
Mikkelsen et al. (Thu,) conducted a cohort in Ischemic heart disease, valvular heart disease, or heart failure (n=1,217). Socioeconomic and psychosocial factors (education, employment, ethnicity, depression) vs. Higher socioeconomic status, Western ethnicity, and no depression was evaluated on Peak oxygen uptake (O2peak) before and after cardiac rehabilitation. Lower educational attainment, unemployment, and non-Western ethnicity were associated with lower peak oxygen uptake before cardiac rehabilitation and less improvement following it.
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