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Greater burden of risk factors and less effect of cardiac rehabilitation in elderly with low educational attainment: The Eu-CaRE study

Research output: Contribution to journalJournal articleResearchpeer-review


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  • Ingunn E Kjesbu
  • Nicolai Mikkelsen
  • Kirstine L Sibilitz
  • Matthias Wilhelm
  • Carlos Pena-Gil
  • Violeta González-Salvado
  • Marie Christine Iliou
  • Uwe Zeymer
  • Esther P Meindersma
  • Diego Ardissino
  • Astrid E van der Velde
  • Arnoud Wj Van 't Hof
  • Ed P de Kluiver
  • Eva Prescott
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AIMS: Socioeconomic status is a strong predictor of cardiovascular health. The aim of this study was to describe the immediate and long-term effects of cardiac rehabilitation (CR) across socioeconomic strata in elderly cardiac patients in Europe.

METHODS AND RESULTS: The observational EU-CaRE study is a prospective study with eight CR sites in seven European countries. Patients ≥65 years with coronary heart disease or heart valve surgery participating in CR were consecutively included. Data were obtained at baseline, end of CR and at one-year follow up. Educational level as a marker for socioeconomic status was divided into basic, intermediate and high. The primary endpoint was exercise capacity (peak oxygen consumption (VO2peak)). Secondary endpoints were cardiovascular risk factors, medical treatment and scores for depression, anxiety and quality of life (QoL). A total of 1626 patients were included; 28% had basic, 48% intermediate and 24% high education. A total of 1515 and 1448 patients were available for follow-up analyses at end of CR and one-year, respectively. Patients with basic education were older and more often female. At baseline we found a socioeconomic gradient in VO2peak, lifestyle-related cardiovascular risk factors, anxiety, depression and QoL. The socioeconomic gap in VO2peak increased following CR (p for interaction <0.001). The socioeconomic gap in secondary outcomes was unaffected by CR. The use of evidence-based medication was good in all socioeconomic groups.

CONCLUSIONS: We found a strong socioeconomic gradient in VO2peak and cardiovascular risk factors that was unaffected or worsened after CR. To address inequity in cardiovascular health, the individual adaption of CR according to socioeconomic needs should be considered.

Original languageEnglish
JournalEuropean Journal of Preventive Cardiology
Issue number5
Pages (from-to)513-519
Number of pages7
Publication statusPublished - May 2021

    Research areas

  • Cardiac rehabilitation, social inequality, socioeconomic status, elderly, secondary prevention

ID: 61986287