Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction?: A 10-year follow-up study

Kathrine Hald; Lucette Kirsten Meillier; Kirsten M Nielsen; Finn Breinholt Larsen; Martin Berg Johansen; Mogens Lytken Larsen; Claus Vinther Nielsen; Bo Christensen

doi:10.1136/bmjopen-2019-030807

Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction? A 10-year follow-up study

Kathrine Hald, Lucette Kirsten Meillier, Kirsten M Nielsen, Finn Breinholt Larsen, Martin Berg Johansen, Mogens Lytken Larsen, Claus Vinther Nielsen, Bo Christensen

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVE: To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).

DESIGN: A prospective cohort study with 10 years' follow-up.

SETTING: Department of cardiology at a university hospital in Denmark between 2000 and 2004.

PARTICIPANTS: Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.

INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.

MAIN OUTCOME MEASURES: Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.

RESULTS: At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).

CONCLUSIONS: The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.

Original language	English
Article number	e030807
Journal	BMJ Open
Volume	9
Issue number	10
Pages (from-to)	1-8
Number of pages	8
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2019-030807
Publication status	Published - Oct 2019

Keywords

myocardial infarction
organisation of health services
primary care
rehabilitation medicine
social medicine

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10.1136/bmjopen-2019-030807Licence: CC BY-NC 4.0

Hald et al (2019) Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarctionFinal published version, 460 KBLicence: CC BY-NC 4.0

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Cite this

@article{3865048b617149f8a10f082331229c36,

title = "Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction?: A 10-year follow-up study",

abstract = "OBJECTIVE: To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).DESIGN: A prospective cohort study with 10 years' follow-up.SETTING: Department of cardiology at a university hospital in Denmark between 2000 and 2004.PARTICIPANTS: Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.MAIN OUTCOME MEASURES: Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.RESULTS: At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).CONCLUSIONS: The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.",

keywords = "myocardial infarction, organisation of health services, primary care, rehabilitation medicine, social medicine",

author = "Kathrine Hald and Meillier, {Lucette Kirsten} and Nielsen, {Kirsten M} and {Breinholt Larsen}, Finn and Johansen, {Martin Berg} and Larsen, {Mogens Lytken} and Nielsen, {Claus Vinther} and Bo Christensen",

year = "2019",

month = oct,

doi = "10.1136/bmjopen-2019-030807",

language = "English",

volume = "9",

pages = "1--8",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Group",

number = "10",

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TY - JOUR

T1 - Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction?

T2 - A 10-year follow-up study

AU - Hald, Kathrine

AU - Meillier, Lucette Kirsten

AU - Nielsen, Kirsten M

AU - Breinholt Larsen, Finn

AU - Johansen, Martin Berg

AU - Larsen, Mogens Lytken

AU - Nielsen, Claus Vinther

AU - Christensen, Bo

PY - 2019/10

Y1 - 2019/10

N2 - OBJECTIVE: To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).DESIGN: A prospective cohort study with 10 years' follow-up.SETTING: Department of cardiology at a university hospital in Denmark between 2000 and 2004.PARTICIPANTS: Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.MAIN OUTCOME MEASURES: Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.RESULTS: At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).CONCLUSIONS: The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.

AB - OBJECTIVE: To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).DESIGN: A prospective cohort study with 10 years' follow-up.SETTING: Department of cardiology at a university hospital in Denmark between 2000 and 2004.PARTICIPANTS: Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.INTERVENTION: A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.MAIN OUTCOME MEASURES: Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.RESULTS: At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).CONCLUSIONS: The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.

KW - myocardial infarction

KW - organisation of health services

KW - primary care

KW - rehabilitation medicine

KW - social medicine

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U2 - 10.1136/bmjopen-2019-030807

DO - 10.1136/bmjopen-2019-030807

M3 - Journal article

C2 - 31662379

SN - 2044-6055

VL - 9

SP - 1

EP - 8

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e030807

ER -