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Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction? A 10-year follow-up study
  1. Kathrine Hald1,
  2. Lucette Kirsten Meillier2,
  3. Kirsten M. Nielsen3,
  4. Finn Breinholt Larsen2,
  5. Martin Berg Johansen4,
  6. Mogens Lytken Larsen5,
  7. Claus Vinther Nielsen1,
  8. Bo Christensen6
  1. 1 Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
  2. 2 DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark
  3. 3 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  4. 4 Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Danish Centre for Inequality in Health, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  6. 6 Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Kathrine Hald; kathrine.hald{at}stab.rm.dk

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.

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

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Footnotes

  • CONTRIBUTORSHIP STATEMENT All authors contributed to the conception and design of the work. All authors contributed to acquisition, analysis and interpretation of data. KH and BC drafted the manuscript. LKM, KMN, FBL, MBJ, MLL and CVN critically revised the manuscript. All authors approved the final version and agree to be accountable for all aspects of work ensuring integrity and accuracy.

  • Funding This work was supported by: Aarhus University (Grant number: 17117581), Central Denmark Region (Grant number: A-111, 1-15-1-72-13-09), The Health Foundation (Grant number: 16-13-0098), The Committee of Multipractice Studies in General Practice (Grant number: 16-1461) and TrygFonden (Grant number: 119795).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Danish Data Protection Agency approved the study (Case number: 1-16-02-684-14). No ethical approval was required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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