Poverty, not distance to facility, confers cardiac rehab attrition
PHILADELPHIA — Neighborhood poverty may be a major factor for early termination of cardiac rehabilitation in New York City, whereas distance to rehabilitation facility may not be, according to the findings presented at the American Heart Association Scientific Sessions.
From data on 1,493 patients enrolled in the NYU Langone Health Rusk Cardiac Rehabilitation Program between 2013 and 2017, researchers identified 28 New York City ZIP codes as areas of high cardiac rehabilitation attrition, 60.7% of which were also high-poverty areas. In these 28 ZIP codes, the median family income was $57,688.
Among the 120 ZIP codes with lower attrition, 30% were high-poverty areas (P < .004 for comparison to high-attrition ZIP codes). The median family income in the lower-attrition ZIP codes was $73,860, according to the study.
“We found that there were specific neighborhoods that had high rates of early termination and they didn’t correlate to how far the distance was to the rehab center,” John A. Dodson, MD, MPH, FACC, director of the NYU Langone geriatric cardiology program, told Healio. “Our rehab center is in Midtown Manhattan, but if you look at Staten Island, some of these ZIP codes had no attrition. These people went to every single session. But then you look somewhere like the Lower East Side, which is physically closer to our rehab center, you had very high attrition. There are certain areas, specifically northern Manhattan, the South Bronx, Brooklyn and Queens, that are high poverty. What we found was that the areas that had high attrition had much higher rates of poverty.”
In other findings, researchers observed that there was no significant correlation between distance to cardiac rehabilitation facility and higher or lower attrition (12.1 ± 6 km vs. 10.6 ± 6.3 km; P = .2).
“We have a database now of about 1,500 patients and we’re the largest rehab center in New York City,” Dodson, who is also assistant professor of medicine and population health at NYU Langone Health, told Healio. “We have a lot of events that we can look at, which is one of the strengths of this study.”
From the 1,493 patients (mean age, 64 years; 33% women; 28% nonwhite), researchers assessed sessions attended, patient characteristics, demographics and home ZIP codes to determine any association between cardiac rehabilitation attrition, patient income and distance from facility.
ZIP codes were identified as high-attrition areas if they were above the 66th percentile of early termination rates, according to the study. Areas were considered high poverty if they were above the 66th percentile in families below poverty level.
“Maybe there are novel approaches we need to take,” Dodson told Healio. “My new grant from the NIH is looking at mobile health cardiac rehab delivery and whether mobile health could be something that can bridge this access gap. If you can’t make it physically to the facility, maybe there’s an approach through your smartphone or to otherwise deliver care remotely.” – by Scott Buzby
Bostrom J, et al. Abstract Mo3122. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: The authors report no relevant financial disclosures.