Racial Disparities in Cardiac Rehabilitation Initiation and the Effect on Survival

Prince, David Z.; Sobolev, Maria; Gao, Ju; Taub, Cynthia C.

doi:10.1016/j.pmrj.2013.11.016

Cited by 34 publications

(38 citation statements)

References 41 publications

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“…Our study represents 1 of the largest analyses to date focused on CR participation following AMI. Prior studies have often been limited to data from single or several hospitals or a focus on the Medicare population . Similar to these studies, we found a strong association between CR nonparticipation and female sex, nonwhite race, lack of insurance, tobacco use, and lower education levels.…”

Section: Discussionsupporting

confidence: 82%

“…Moreover, even when prescribed, rates of patient participation in CR have been historically low due to limited access, lack of insurance coverage, and out-of-pocket cost for co-pays. [8][9][10] Although data from the 1990s and early 2000s have demonstrated the effect of demographic and socioeconomic factors on CR referral and participation, [10][11][12][13][14][15] current data are lacking. The goal of this study was to assess the current trends in CR participation after AMI in the United States and to identify predictors of participation.…”

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confidence: 99%

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Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Peters

Keeley

2018

JAHA

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BackgroundParticipation in cardiac rehabilitation (CR) after acute myocardial infarction has been proven to significantly reduce morbidity and mortality. Historically, participation rates have been low, and although recent efforts have increased referral rates, current data on CR participation are limited.Methods and ResultsUtilizing data from the Behavioral Risk Factor Surveillance System conducted by Centers for Disease Control and Prevention, we performed a population‐based, cross‐sectional analysis of CR post‐acute myocardial infarction. Unadjusted participation from 2005 to 2015 was evaluated by univariable logistic regression. Multivariable logistic regression was performed with patient characteristic variables to determine adjusted trends and associations with participation in CR in more recent years from 2011 to 2015. Among the 32 792 survey respondents between 2005 and 2015, participation ranged from 35% in 2005 to 39% in 2009 (P=0.005) and from 38% in 2011 to 32% in 2015 (P=0.066). Between 2011 and 2015, participants were less likely to be female (odds ratio [OR] 0.763, 95% confidence interval [CI] 0.646‐0.903), black (OR 0.700, 95% CI 0.526‐0.931), uninsured (OR 0.528, 95% CI 0.372‐0.751), less educated (OR 0.471, 95% CI 0.367‐0.605), current smokers (OR 0.758, 95% CI 0.576‐0.999), and were more likely to be retired or self‐employed (OR 1.393, 95% CI 1.124‐1.726).ConclusionsOnly one third of patients participate in CR following acute myocardial infarction despite the known health benefits. Participants are less likely to be female, black, and uneducated. Future studies should focus on methods to maximize the proportion of CR referrals converted into CR participation.

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Section: Discussionsupporting

confidence: 82%

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confidence: 99%

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Peters

Keeley

2018

JAHA

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“…Cardiac rehabilitation initiation was associated with cardiologist involvement. Initiation was associated with a survival benefit, and there were no differences between white and nonwhite patients in survival benefit for those patients initiating rehabilitation (74). Even in a community of a predominantly minority population, racial disparity exists among cardiac rehabilitation participants.…”

Section: Patient/health Care Provider Team-based Engagement Strategiesmentioning

confidence: 99%

Improving Medication Adherence in Cardiometabolic Disease

Ferdinand

Senatore

Clayton-Jeter

et al. 2017

Journal of the American College of Cardiology

139

105

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Medication nonadherence, a major problem in cardiovascular disease (CVD), contributes yearly to approximately 125,000 preventable deaths, which is partly attributable to only about one-half of CVD patients consistently taking prescribed life-saving medications. Current interest has focused on how labeling and education influence adherence. This paper summarizes the scope of CVD nonadherence, describes key U.S. Food and Drug Administration initiatives, and identifies potential targets for improvement. We describe key adherence factors, methods, and technological applications for simplifying regimens and enhancing adherence, and 4 areas where additional collaborative research and implementation involving the regulatory system and clinical community could substantially reduce nonadherence: 1) identifying monitoring methods; 2) improving the evidence base to better understand adherence; 3) developing patient/health provider team-based engagement strategies; and 4) alleviating health disparities. Alignment of U.S. Food and Drug Administration approaches to dissemination of information about appropriate use with clinical practice could improve adherence, and thereby reduce CVD death and disability.

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“…CR participation increases quality of life and decreases the risk of all‐cause mortality, CVD mortality, and recurrent CVD events . Unfortunately, CR is profoundly underutilized, with only 15% to 20% of eligible patients participating in CR programs nationally . CR participation rates are particularly low in underrepresented minorities, and are lower than the national average in the southeastern United States …”

Section: Introductionmentioning

confidence: 99%

“…Barriers to participation in CR are myriad, spanning patient, physician, community, and health system factors, and there are marked ethnic and regional disparities in CR referral and participation rates . One of these patient factors, individual socioeconomic status, is directly associated with CR participation .…”

Section: Introductionmentioning

confidence: 99%

Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation

Bachmann

Huang

Gupta

et al. 2017

JAHA

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BackgroundCardiac rehabilitation (CR) is underutilized in the United States, with fewer than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but data regarding neighborhood characteristics and CR are sparse. We investigated the association of neighborhood socioeconomic context with CR participation in the SCCS (Southern Community Cohort Study).Methods and ResultsThe SCCS is a prospective cohort study of 84 569 adults in the southeastern United States from 2002 to 2009, 52 117 of whom have Medicare or Medicaid claims. Using these data, we identified participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a neighborhood deprivation index derived from 11 census‐tract level variables. We analyzed the association of CR utilization with neighborhood deprivation after adjusting for individual socioeconomic status. A total of 4096 SCCS participants (55% female, 57% black) with claims data were eligible for CR. CR utilization was low, with 340 subjects (8%) participating in CR programs. Study participants residing in the most deprived communities (highest quintile of neighborhood deprivation) were less than half as likely to initiate CR (odds ratio 0.42, 95% confidence interval, 0.27–0.66, P<0.001) as those in the lowest quintile. CR participation was inversely associated with all‐cause mortality (hazard ratio 0.77, 95% confidence interval, 0.60–0.996, P<0.05).ConclusionsLower neighborhood socioeconomic context was associated with decreased CR participation independent of individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.

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Racial Disparities in Cardiac Rehabilitation Initiation and the Effect on Survival

Cited by 34 publications

References 41 publications

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Improving Medication Adherence in Cardiometabolic Disease

Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation

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