Trends and disparities in referral to cardiac rehabilitation after percutaneous coronary intervention

Aragam, Krishna; Moscucci, Mauro; Smith, Dean E.; Riba, Arthur; Zainea, Mark; Chambers, James; Share, David; Gurm, Hitinder S.

doi:10.1016/j.ahj.2010.11.016

Cited by 67 publications

(60 citation statements)

References 39 publications

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“…Prior research on CR mainly focused on 2 areas: (1) identifying predictors for CR referral and initiation8, 9, 17, 18, 19, 20, 21 and (2) estimating the effects of CR participation with subsequent outcomes, such as mortality 22, 23, 24. For (1), the majority of evidence was collected from white males 25.…”

Section: Introductionmentioning

confidence: 99%

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

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BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival.Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral.Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.

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Section: Introductionmentioning

confidence: 99%

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

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“…In high-income countries, physician referral to CR has been highlighted as a key barrier in several studies. 88,40,42,[89][90][91][92] Findings of these studies reported 33%-71% of eligible patients were not referred, and hence were unable to access to CR (Table 4), despite the scientific statements and evidence-based guidelines on referral to CR. 93 Recently, data from the EUROASPIRE III Survey, conducted in 22 European countries (19 of which were high-income countries), showed that 44.8% of the 8,845 patients eligible for CR were advised by physicians or other healthcare professionals to attend a CR program.…”

Section: Availability Of Cr To Patients Physician Referralmentioning

confidence: 99%

Section: Disparities In Patient Access To Crmentioning

confidence: 99%

“…19,90,91 Certain vulnerable groups are less likely to be referred, and hence participate in CR. 19,90,91 This includes women, the elderly, ethnocultural minorities, patients of low socioeconomic status, and with comorbidities. 90,91,99 Paradoxically, these patients often have greater need for CR due to greater disease management complexity or evidence of poorer outcomes.…”

Section: Disparities In Patient Access To Crmentioning

confidence: 99%

“…19,90,91 This includes women, the elderly, ethnocultural minorities, patients of low socioeconomic status, and with comorbidities. 90,91,99 Paradoxically, these patients often have greater need for CR due to greater disease management complexity or evidence of poorer outcomes. In middle-income countries, women are similarly less represented than men (<30%) in CR.…”

Section: Disparities In Patient Access To Crmentioning

confidence: 99%

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Global availability of cardiac rehabilitation

2014

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The most prevalent non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of the deaths occurring in low-and middleincome countries. To lessen the impact of CVDs on individuals and societies, a comprehensive approach is needed. Cardiac rehabilitation (CR) involves delivery of structured exercise, education and risk reduction, in a cost-effective manner. Robust evidence demonstrates it reduces mortality up to 25%, improves functional capacity, as well as decreases re-hospitalization. Despite its benefits, and clinical practice guideline recommendations to refer cardiac patients, CR programs are grossly under-used. Worldwide, there is low availability of CR; only 38.8% of countries globally have CR programs. Specifically, 68.0% of high-income and 23% of LMICs (28.2% for middle-and 8.3% for low-income countries) have CR. CR density estimates ranged from 1 program per 0.1-6.4 million inhabitants. CR availability is much lower than that of other evidencebased secondary prevention therapies, such as revascularization and pharmacological therapies. Multi-level strategies to augment CR capacity and availability at national and international levels such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed.

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