Key result
Frequent financial strain links to greater improvement in depressive symptoms after cardiac rehabilitation.
Why the study?
Cardiac rehabilitation aids post-cardiac event recovery, but whether outcomes differ by socioeconomic characteristics in low-resource settings remains unclear.
Are socioeconomic characteristics associated with cardiac rehabilitation completion and changes in depressive symptoms and quality of life in low-resource settings?
Observational (n=3,520)
Yes
Are socioeconomic characteristics associated with cardiac rehabilitation completion and changes in depressive symptoms and quality of life in low-resource settings?
Mean Difference: -0.337 (95% CI -0.534–-0.14)
p-value: p=0.021
In low-resource settings, socioeconomic pressures such as financial strain and employment status are associated with differences in recovery of depressive symptoms following cardiac rehabilitation.
Socioeconomic factors may modify depressive recovery after cardiac rehab; hypothesis-generating in this observational cohort and needs prospective validation.
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.
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Manandi et al. (2026) conducted an observational in Cardiac rehabilitation (n=3,520). Socioeconomic characteristics (financial strain, education, employment) vs. Reference socioeconomic groups was evaluated on Change in Patient Health Questionnaire-2 depressive symptoms (β=-0.337, 95% CI -0.534 to -0.140, p=0.021). Reporting financial strain as 'often' was associated with greater improvement in depressive symptoms (β=-0.337; 95% CI -0.534 to -0.140; P=0.021) among patients completing cardiac rehabilitation.
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