Detrimental impact of socioeconomic status on exercise capacity in adults with congenital heart disease.

Abstract Objectives To evaluate the relationship between socioeconomic status (SES), access to physical activity resources, urban–rural dwelling, levels of pollution and exercise capacity in adult congenital heart disease (ACHD) patients. Background Exercise intolerance is prevalent in ACHD and the contributing factors are poorly understood. Methods A total of 1268 ACHD patients living in England who underwent cardiopulmonary exercise testing at our center were included. Neighborhood deprivation (English Indices of Deprivation), urban–rural dwelling, availability of green space, distance to the closest gym/fitness center and levels of pollution were estimated based on administrative data. Results Urban–rural dwelling, availability of green space and levels of pollution were unrelated to exercise capacity. Lower SES was associated with a significantly lower peak oxygen consumption ( P P P =0.015) and smoking ( P =0.01). Coronary artery disease was rare in this young population and low SES was found to be related to exercise capacity independently of the presence of coronary artery disease. Conclusions Living in poorer areas is associated with exercise intolerance in contemporary ACHD patients. Although low SES is linked to traditional cardiovascular risk factors, the deleterious effects of SES on exercise capacity seem to be only partially mediated via coronary artery disease. Reducing social inequalities in ACHD patients may have a positive effect on quality of life and long-term prognostic implications.