Key result
High neighborhood deprivation is linked to ~20% higher cardiovascular rehospitalization rates.
Why the study?
Neighborhood socioeconomic status is associated with health outcomes, but the association of the Area Deprivation Index with recurrent cardiovascular outcomes and the potential modifying effect of cardiac rehabilitation required evaluation.
Does high neighborhood deprivation increase the risk of recurrent cardiovascular outcomes in patients with MI or incident HF, and does cardiac rehabilitation mitigate this risk?
Cohort (n=6,957)
No
Does high neighborhood deprivation increase the risk of recurrent cardiovascular outcomes in patients with MI or incident HF, and does cardiac rehabilitation mitigate this risk?
Higher neighborhood socioeconomic deprivation is associated with increased rehospitalization and mortality in cardiovascular disease, but participation in cardiac rehabilitation may significantly mitigate these adverse outcomes.
Answers are grounded in this paper and cite their sources.
May inform targeted post-MI/HF follow-up; confirms deprivation-rehospitalization link in observational data but leaves mitigation open for trials.
INTRODUCTION: Neighborhood socioeconomic status is associated with health outcomes. Cardiac rehabilitation (CR) provides a cost-effective, multidisciplinary approach to improve outcomes in cardiovascular disease. We aimed to evaluate the association of the Area Deprivation Index (ADI), a marker of neighborhood social composition, with risk of recurrent cardiovascular outcomes and assessed the modifying effect of CR. METHODS: We identified patients with a primary diagnosis of (1) myocardial infarction or (2) incident heart failure (HF) admitted to a large-sized regional health center during 2010-2018. We derived the ADI from home addresses and categorized it into quartiles (higher quartiles indicating increased deprivation). We obtained number of CR visits and covariates from the health record. We compared rehospitalization (cardiovascular, acute coronary syndrome [ACS], and HF) and mortality rates across ADI quartiles. RESULTS: We included 6957 patients (age 69.2 ± 13.4 yr, 38% women, 89% White race). After covariate adjustment, the ADI was significantly associated with higher incidence rates (IRs)/100 person-yr of cardiovascular rehospitalization (quartile 1, IR 34.6 [95% CI, 31.2-38.2]; quartile 4, 41.5 [95% CI, 39.1-44.1], P < .001). In addition, the ADI was significantly associated with higher rates of rehospitalization for HF (P < .001), ACS (P < .012), and all-cause mortality (P < .04). These differences in rehospitalization and mortality rates by the ADI were no longer significant in those who attended CR. CONCLUSIONS: We found the increased ADI was adversely associated with rehospitalizations and mortality. However, in individuals with CR, outcomes were significantly improved compared with those with no CR. Our findings suggest that CR participation has the potential to improve outcomes in disadvantaged neighborhoods.
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Guhl et al. (2021) conducted a cohort in Myocardial infarction or incident heart failure (n=6,957). High neighborhood deprivation (Area Deprivation Index Quartile 4) vs. Low neighborhood deprivation (Area Deprivation Index Quartile 1) was evaluated on Cardiovascular rehospitalization (incidence rate per 100 person-years) (p=<0.001). Higher neighborhood deprivation (ADI quartile 4) was associated with a higher incidence of cardiovascular rehospitalization compared to the lowest deprivation quartile.
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