Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization.
Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization.
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社区层面的痛苦与心脏康复参与、设施使用以及住院冠状动脉血运重建后临床结果之间的关系。
DOI：
10.1161/circoutcomes.123.010148
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Likosky,DonaldS
中科院分区：
文献类型：
--
作者：
Thompson,MichaelP;Hou,Hechuan;Stewart2nd,JamesW;Pagani,FrancisD;Hawkins,RobertB;Keteyian,StevenJ;Sukul,Devraj;Likosky,DonaldS
背景：尽管参与心脏康复(CR)的差异有很好的文献记载，但社区层面的痛苦所起的作用却知之甚少。这项研究评估了社区层面的痛苦与CR参与度、CR设施的使用情况以及临床结果之间的关系。METHODSA回顾队列研究是在2016年7月至2018年12月期间对接受冠状动脉血运重建的100%医疗保险受益人进行的。使用受益邮政编码一级的受灾社区指数五分位数来定义社区一级的痛苦，第一和第五分位数分别代表繁荣和痛苦的社区。门诊索赔用于确定出院后1年内的任何CR使用情况。受益人和CR设施的邮政编码用于描述对CR设施的访问。调整后的Logistic回归模型评估了不良社区指数五分位数、CR使用率和临床结果之间的关系，包括一年死亡率、全因住院和急性心肌梗死住院。结果总共确定了414名 730受益人，其中96名 929(23.4%)位于第一个五分位数，67个 900(16.4%)位于第五个五分位数。与繁荣社区相比，贫困社区受益人的CR使用率更低(26.0%比46.1%，P<；0.001)，这在多变量调整后显著(优势比，0.41[95%可信区间，0.40-0.42])。共有98名 458(23.7%)受益人在其邮政编码范围内拥有CR设施，这一比例从富裕社区的16.3%上升到贫困社区的26.6%。任何CR的使用都与死亡率(−6.8%[95%CI，−7.0%至−6.7%])、全因住院(−5.9%[95%CI，−6.3%至−5.6%])和急性心肌梗死住院(−1.3%[95%CI，−1.5%至−1.1%])的绝对减少有关，这在每五个不良社区指数中都是相似的。解决贫困社区的CR障碍应该被认为是提高冠状动脉血运重建后存活率和减少差异的重要优先事项。
BACKGROUNDAlthough disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes.METHODSA retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization.RESULTSA total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%,P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40–0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (−6.8% [95% CI, −7.0% to −6.7%]), all-cause hospitalization (−5.9% [95% CI, −6.3% to −5.6%]), and acute myocardial infarction hospitalization (−1.3% [95% CI, −1.5% to −1.1%]), which were similar across each Distressed Community Index quintiles.CONCLUSIONSAlthough community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.
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DOI：
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