Disparities in the Use of Cardiac Rehabilitation in African Americans

Abstract

Purpose of review Cardiac rehabilitation (CR) is a comprehensive outpatient program that reduces the risk of mortality and recurrent events and improves functional status and quality of life for patients recovering from acute cardiovascular disease (CVD) events. Among individuals with established CVD, African Americans have a higher risk of major cardiac events, which underscores the importance of CR use among African Americans. However, despite their high likelihood of adverse outcomes, CR is poorly utilized in African Americans with CVD. We review data on CR utilization among African Americans, barriers to participation, and the implications for policy and practice. Recent findings Although established as a highly effective secondary prevention strategy, CR is underutilized in general, but especially by African Americans. Notwithstanding efforts to increase CR participation among all groups, participation rates remain low for African Americans and other minorities compared to Non-Hispanic Whites. The low CR participation rates by African Americans can be attributed to an array of factors including differential referral patterns, access to care, and socioeconomic factors. There are several promising strategies to improve CR participation which include promoting evidence-based guidelines, reducing barriers to access, novel CR delivery modalities, including more African Americans in CR clinical research, and increasing diversity in the CR workforce. Summary African Americans with CVD events are less likely to be referred to, enroll in, and complete CR than Non-Hispanic Whites. There are many factors that impact CR participation by African Americans. Initiatives at the health policy, health system, individual, and community level will be needed to reduce these disparities in CR use.

Relationship of Race With Functional and Clinical Outcomes With the REHAB‐HF Multidomain Physical Rehabilitation Intervention for Older Patients With Acute Heart Failure

“…In contrast, in patients who have established cardiovascular disease or are recovering from an acute cardiovascular disease event, non‐White individuals have lower enrollment in and adherence to outpatient cardiac rehabilitation than White individuals, despite the well‐described benefits associated with cardiac rehabilitation on long‐term health outcomes. 8 , 9 , 10 , 11 Thus, evaluating whether the effects of physical rehabilitation interventions vary across racial groups in ADHF is a critical first step toward the end goal of appropriately personalizing care to reduce disparities and optimize outcomes.…”

Comparing exercise determinants between Black and White older adults with heart failure

“…For example, at the behavioral level, there is evidence that Black individuals participate in lower levels of physical activity when controlling for social contextual factors [ 4 ] that likely contribute to exacerbating the risk of cardiac events incidence, prevalence, and recovery. At the social level, cardiac rehabilitation among Black individuals with HF is less utilized due to access barriers, lack of referral by healthcare providers, awareness or perceived benefits of cardiac rehabilitation, implicit biases, and low adherence to cardiac rehabilitation [ 5 – 7 ]. These findings have become salient in the literature, and hence, there have been recent calls to assess putative individual and social determinants that explain racial disparities in order to prevent and manage HF among Black individuals [ 8 – 10 ].…”