Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use

Mead, Holly; Ramos, Christal; Grantham, Sarah

doi:10.1177/1077558715606261

Cited by 27 publications

(45 citation statements)

References 38 publications

(43 reference statements)

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“…90 Finally, the interplay between gender and ethnicity warrants further investigation, particularly because women in underrepresented minority groups experience various health care disparities, including the underutilization of CR services. 91 …”

Section: Discussionmentioning

confidence: 99%

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Supervía

Medina‐Inojosa

Yeung

et al. 2017

Mayo Clinic Proceedings

164

148

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Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.

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Section: Discussionmentioning

confidence: 99%

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Supervía

Medina‐Inojosa

Yeung

et al. 2017

Mayo Clinic Proceedings

164

148

View full text Add to dashboard Cite

show abstract

“…In addition to gender disparities, racial and ethnic factors also contribute to lower CR referral and completion rates. Several studies have shown lower CR referral rates for nonwhite individuals as compared to white individuals [47][48][49]. In a study by Aragam et al, hospitals with high CR referral rates (> 90%), reported no difference in CR referrals between white vs. non-white patients [30].…”

Section: Gender and Racialmentioning

confidence: 99%

Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers

Chindhy

Taub

Lavie

et al. 2020

Expert Review of Cardiovascular Therapy

107

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Introduction: Cardiac rehabilitation (CR) significantly reduces secondary cardiovascular events and mortality and is a class 1A recommendation by the American Heart Association (AHA) and American College of Cardiology (ACC). However, it remains an underutilized intervention and many eligible patients fail to enroll or complete CR programs. The aim of this review is to identify barriers to CR attendance and discuss strategies to overcome them.Areas Covered: Specific barriers to CR attendance and participation will be reviewed. This will be followed by a discussion of solutions/strategies to help overcome these barriers with a particular focus on home-based CR (HBCR).Expert Opinion: HBCR alone or in combination with center-based CR (CBCR) can help overcome many barriers to traditional CBCR participation, such as schedule flexibility, time commitment, travel distance, cost, and patient preference. Using remote coaching with indirect exercise supervision, HBCR has been shown to have comparable benefits to CBCR. At this time however, funding remains the main barrier to universal incorporation of HBCR into health systems, necessitating the need for additional cost benefit analysis and outcome studies. Ultimately the choice for HBCR should be based on patient preference and availability of resources.

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“…Second, the sample consisted of predominately-White males enrolled in a CRP, which limits the generalization of study results to racial and ethnic minorities who carry the heaviest burden of adverse cardiac events such as myocardial infarction, ischemic heart disease, and heart failure (Virani et al, 2020; Whelton et al, 2017). In contrast, while the current participation in CRP is about 20% to 30% (Ades et al, 2017), approximately 7% to 11% of racial-ethnic minorities use CRPs (Mead et al, 2016). However, African Americans, Hispanics, and Asians populations are 20%, 30%, and 50%, respectively, less likely to be referred to, participate in, or benefit from CRP (Li et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Effects of the Intensity of Lifestyle Exercise on Changes in Blood Pressure

2020

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The purpose of this study was to investigate whether the amount of time participants exercised in the target heart rate zone (THRZ) influenced change in blood pressure (BP) one year following a cardiac event. Lifestyle exercise (habitual, small exercise opportunities) and intensity were objectively measured using portable heart rate monitors. Linear mixed models were used to analyze change in BP among 331 participants. Mean BP at baseline was 118/70 mmHg, and both systolic and diastolic BP increased from baseline to one year—4.79 mmHg ( p <.001) and 2.09 mmHg ( p =.002), respectively. Overall, participants had a decrease in levels of lifestyle exercise. After controlling for time, age, gender, and study group, SBP change was inversely associated with amount of time in THRZ. Given suboptimal engagement in recommended exercise, the underlying mechanisms of lifestyle exercise effects on the time spent in THRZ to reduce BP warrants further study in this population.

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Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use

Cited by 27 publications

References 38 publications

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers

Effects of the Intensity of Lifestyle Exercise on Changes in Blood Pressure

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