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Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort

2018Journal article Open access
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dc.contributor.authorViana, Marta
dc.contributor.authorBorges, Andreia
dc.contributor.authorAraújo, Carla
dc.contributor.authorRocha, Afonso
dc.contributor.authorRibeiro, Ana
dc.contributor.authorLaszcznska, Olga
dc.contributor.authorDias, Paula
dc.contributor.authorMaciel, Maria J.
dc.contributor.authorMoreira, Ilidio
dc.contributor.authorLunet, Nuno
dc.contributor.authorAzevedo, Ana
dc.date.accessioned2018-11-25T00:02:26Z
dc.date.available2018-11-25T00:02:26Z
dc.date.issued2018
dc.description.abstractOBJECTIVES: To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions. DESIGN: Prospective cohort study. SETTING: Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months. PARTICIPANTS: Between August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up. OUTCOME MEASURES: Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians. RESULTS: Patients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers. CONCLUSIONS: CR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.pt_PT
dc.description.sponsorshipFEDER through the Operational Programme Competitiveness and Internationalisation
dc.description.sponsorshipFoundation for Science and Technology-FCT (Portuguese Ministry of Science, Technology and Higher Education)
dc.description.sponsorshipUnidade de Investigacao em Epidemiologia-Instituto de Saude Publica da Universidade do Porto (EPIUnit)
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBMJ Open. 2018 Jan 3;8(1):e018934. doi: 10.1136/bmjopen-2017-018934.pt_PT
dc.identifier.doi10.1136/bmjopen-2017-018934pt_PT
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/10400.26/25002
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJ Publishing Grouppt_PT
dc.relationInequalities in coronary heart disease management and outcomes in Portugal
dc.relationEpidemiology Research Unit - Institute of Public Health, University of Porto
dc.relation.publisherversionhttps://bmjopen.bmj.com/content/8/1/e018934.longpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectacute coronary syndromept_PT
dc.subjectcardiac rehabilitationpt_PT
dc.subjecthealthcare inequalitiespt_PT
dc.titleInequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohortpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleInequalities in coronary heart disease management and outcomes in Portugal
oaire.awardTitleEpidemiology Research Unit - Institute of Public Health, University of Porto
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/5876-PPCDTI/PTDC%2FDTP-EPI%2F0434%2F2012/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UID%2FDTP%2F04750%2F2013/PT
oaire.citation.issue1ª Ediçãopt_PT
oaire.citation.titleBMJ OPENpt_PT
oaire.citation.volume8pt_PT
oaire.fundingStream5876-PPCDTI
oaire.fundingStream6817 - DCRRNI ID
person.familyNameViana
person.givenNameMarta
person.identifier.orcid0000-0002-5657-5570
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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relation.isAuthorOfPublication.latestForDiscovery1b086216-eb5e-421f-b7a1-1ce589dc4af2
relation.isProjectOfPublicatione29d79c3-560f-4ea9-99e1-a03776d5c3c2
relation.isProjectOfPublicationbf0d2b5f-ce73-4e53-9bc2-7e82b137d9e2
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