ArticleBMJ open2018
Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Barriers to Participation and Adherence in Cardiac Rehabilitation Programmes: A Scoping Review of Recent Evidence from Industrialized and Developing Countries.Reviews in cardiovascular medicine · 2026Review
- Comparing disparities in geographic proximity to exercise-based cardiac rehabilitation before and after decentralisation of services: a repeated cross-sectional study using individual-level register data.International journal for equity in health · 2025Article
- Association between socio-economic status and outcomes among critically ill Covid-19 adult patients in France.Annals of intensive care · 2025Article
- Race or ethnicity and education in cardiac rehabilitation enrollment.Journal of cardiology · 2024Article
- The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review.International journal for equity in health · 2024Article
- Barriers to Participation in Cardiac Rehabilitation Among Patients with Coronary Heart Disease After Reperfusion Therapy: A Scoping Review.Vascular health and risk management · 2023Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions.
designProspective cohort study.
settingPatients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months.
participantsBetween August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up. OUTCOME MEASURES: Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians.
resultsPatients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers.
conclusionsCR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.
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