Improving Cardiac Rehabilitation Adherence in Patients With Lower Socioeconomic Status: A Randomized Clinical Trial.

Importance: Participation in cardiac rehabilitation is associated with significant decreases in morbidity and mortality. Despite the proven benefits, cardiac rehabilitation is severely underutilized in certain populations, specifically those with lower socioeconomic status (SES).

Objective: To assess the efficacy of early case management and/or financial incentives for increasing cardiac rehabilitation adherence among patients with lower SES.

Cardiac rehabilitation: the gateway for secondary prevention.

Cardiac rehabilitation (CR) is a multidisciplinary supervised programme which typically consists of tailored exercise and education on lifestyle management and risk factor modification in cardiac patients. Participation in CR reduces morbidity and mortality, while improving quality of life following major cardiovascular events. Despite the benefits of CR, it is underutilised, generally in the 20%-30% range for eligible patients.

Lower-Socioeconomic Status Patients Have Extremely High-Risk Factor Profiles on Entry to Cardiac Rehabilitation.

Purpose: Patients with lower socioeconomic status (SES) have higher rates of cardiovascular events, yet are less likely to engage in secondary prevention such as cardiac rehabilitation (CR). Given the low number of lower-SES patients entering CR, characterization of this population has been difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower- and higher-SES patients eligible for secondary prevention.

Financial incentives and case management to improve cardiac rehabilitation participation among patients with lower socio-economic status: Rationale and protocol for a randomized controlled trial.

Background: Participation in phase 2 cardiac rehabilitation (CR) is associated with significant decreases in morbidity and mortality. Unfortunately, attendance at CR is not optimal and certain populations, such as those with lower-socioeconomic status (SES), are less likely to participate. In order to remedy this disparity we have designed a trial to examine the efficacy of early case management and/or financial incentives for increasing CR participation among lower-SES patients.

Objective measure of smoking status highlights disparities by sex.

Current smoking is the strongest predictor of future morbidity and mortality in those with cardiovascular disease, yet clinically, smoking status is usually ascertained through self-report. We objectively measured smoking status, using exhaled carbon monoxide (CO), for 1122 consecutive patients entering cardiac rehabilitation. Within those with elevated CO levels (≥4 ppm), females had CO levels almost twice that of males (20.

Carbon monoxide monitoring to objectively measure smoking status in cardiac rehabilitation.

Objective: Participation in cardiac rehabilitation (CR) is associated with reduced morbidity and mortality. However, most programs rely on self-report measures when assessing the critical risk factor of smoking. This study examined smoking status using self-report versus objective measurement using expired carbon monoxide (CO) and compared patient characteristics by CO level.