Socio-geographical factors associated with cardiac rehabilitation participation after percutaneous coronary intervention: a registry-based cohort study from France

AIMS: Cardiac rehabilitation (CR) after percutaneous coronary intervention (PCI) for acute (ACS) or chronic (CCS) coronary syndrome is underutilized worldwide. The determinants of underuse are not fully understood. Using real-world data, this study explored the effect of socio-geographical factors on CR participation. METHODS AND RESULTS: Patients from the Aquitaine region (France) who underwent PCI between 2017 and 2019 were selected from a regional PCI register. Their 1-year CR participation was tracked using the French hospital database. Associations between CR participation and socio-geographical factors (social deprivation, general practitioner accessibility, and distance to the nearest CR centre) were assessed through logistic regression mixed models at 1 and 3 months in ACS, and at 3 and 6 months in CCS. Among the 19 002 patients, 5073 (26.7%) participated in CR (ACS: 4071, 33.0%; CCS: 1002, 15.0%). A CR centre distance >25 km reduced participation at 3 months in ACS patients [odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.70-0.99, P = 0023] but not at 1 month after PCI. Chronic coronary syndrome patients from most advantaged areas were more likely to participate in CR at 3 (OR = 0.62, 95% CI: 0.44-0.88, P = 0.002) and 6 months (OR = 0.59, 95% CI: 0.42-0.82, P < 0.001). General practitioner accessibility did not affect participation. CONCLUSION: Post-PCI CR participation was low. Proximity to CR centres promoted participation for ACS patients, while CR usage correlated with higher socioeconomic status for CCS patients. These findings highlight socio-geographical inequalities in CR access, providing a basis for targeted interventions, such as telerehabilitation or expanded coverage.