‘Practical efforts’ needed to address race disparities in cardiac rehab
Asian, Black and Hispanic adults are up to 43% less likely to attend cardiac rehabilitation compared with white adults with a qualifying diagnosis, with the differences persisting across all income levels, researchers reported.
“Our study confirmed that cardiac rehabilitation participation is low in insured adults with qualifying diagnoses, as recognized by prior studies,” Jared W. Magnani, MD, MSC, associate professor of medicine at the Center for Research on Healthcare and the Heart and Vascular Institute at the University of Pittsburgh and University of Pittsburgh Medical Center, told Healio. “Our work further indicated that participation is lower among Asian, Black and Latino individuals, also consistent with prior work. However, we identified that these racial and ethnic differences are not mitigated by annual household income; racial and ethnic disparities in cardiac rehab participation persist even when stratifying by income level.”
Claims data by race
In a retrospective analysis of claims data, Magnani and colleagues identified 107,199 adults with a cardiac rehab-qualifying diagnosis between January 2016 and December 2018 in Optum’s de-identified Clinformatics database. Cardiac rehab-eligible events included those covered by Medicare that required procedural intervention, such as acute MI listed as the first or second diagnosis, CABG, valve repair or replacement and PCI. Researchers evaluated associations between race or ethnicity and participation in cardiac rehab and assessed interaction between race and annual household income. The mean age of participants was 70 years; 37.4% were women and 76% were white. The primary outcome was defined as participation in at least one session in cardiac rehab in the 1 year after the qualifying event, stratified by race. Secondary outcomes included the number of rehab sessions attended and time to initiation of cardiac rehab, defined as the number of days from discharge to initial session.
The findings were published in the Journal of the American Heart Association.
Overall, 26.5% of eligible patients attended at least one cardiac rehab session.
Compared with white patients, the probability of attending cardiac rehab was 31% lower for Asian individuals (95% CI, 27-36), 19% lower for Black individuals (95% CI, 16-22) and 43% lower for Hispanic individuals (95% CI, 40-45; P < .0001 for all comparisons).
“Furthermore, these racial and ethnic differences in cardiac rehab participation were more pronounced among those aged at least 65 years compared with those aged younger than 65 years, particularly for Asian and Hispanic individuals,” the researchers wrote.
Time to attendance at a cardiac rehab was also longer for Asian, Black and Hispanic patients vs. white patients. Compared with white adults, time to initiation of cardiac rehab was an adjusted 9.4 (95% CI, 5.2-13.7), 10.4 (95% CI, 8.1-12.8) and 8.5 (95% CI, 5.8-11.2) days longer for Asian, Black and Hispanic individuals, respectively.
‘Equitable secondary prevention’ needed
“Cardiac rehab is an evidence-based, highly validated multidisciplinary program,” Magnani told Healio. “Our findings indicate the continued importance of addressing the structural factors which limit its accessibility. We need innovative strategies and practical efforts to neighborhoods and individuals to achieve equitable secondary prevention.”
When assessing by income level, Asian, Black and Hispanic patients were less likely to attend cardiac rehab compared with white patients at all income levels, though attendance did differ significantly by income level.
“Disparities in cardiac rehabilitation participation have been well-documented; however, it is alarming to see the magnitude of the disparities that continue to persist,” Joshua H. Garfein, MPH, a medical student at the University of Pittsburgh, told Healio. “We were surprised to find that the racial or ethnic disparities did not decrease at higher income levels, which means we need to do more research to identify the barriers.”
For more information:
Jared W. Magnani, MD, can be reached at magnanij@pitt.edu; Twitter: @jared_w_magnani.
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