Sex, racial disparities found in cardiac rehab referral

By Allen Cone  |  April 10, 2018 at 3:15 PM
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April 10 (UPI) -- Researchers have found substantial sex and racial differences for cardiac rehabilitation referrals by hospitals upon discharge, situations they say that lead to lower survival rates.

The researchers found the gaps are especially noticeable among females, African-Americans, Hispanic and Asian patients. Their findings were published in the Journal of the American Heart Association.

One third of all deaths in the United States are attributed to heart disease, stroke and other cardiovascular diseases, according to the American Heart Association. That included 801,000 deaths from cardiovascular diseases, 370,000 from heart disease and 129,000 from strokes.

While rehabilitation is known to be beneficial to cardiac patients, the researchers say they are unsure why medical providers' referrals vary based on sex and race.

"Cardiac rehabilitation referral is recommended for eligible patients, regardless of sex or race," Dr. Shanshan Li, an assistant professor of medicine at Boston University School of Medicine, told UPI. "Prior studies suggest that the most easily overcome barrier to CR participation is the lack of CR referral at hospital discharge."

For the study, researchers examined data from 48,993 coronary artery disease patients at 365 hospitals across the United States between 2003 and 2009. The names were derived from the American Heart Association's Get With The Guideline Coronary Artery Disease registry.

They found only 40 percent of eligible patients received a cardiac rehabilitation referral and 77 percent received a physical activity recommendation. But females were 12 percent less likely to receive cardiac rehabilitation referral compared with males. Among other demographics, it was 20 percent for African-Americans, 36 percent for Hispanics and 50 percent for, Asian patients.

They also found patients in the Midwest region were 2.5 times more likely to receive a referral compared with those in the Northeast region. And females were less likely to receive physical activity recommendations.

Rehab referral at hospital discharge was associated with a 40 percent lower 3-year all-cause mortality among all patients. Among women it also around 40 percent. For minorities, there was a 25 percent lower mortality for African American, 38 percent for Hispanics and 37 percent for Asian compared with those who did not receive rehab referral.

They found 7 percent of the black vs. white mortality gap could potentially be reduced by equitable rehab referrals.

Compared with white patients, black patients were 1.3 times more likely to die at year 1 and year 3 post hospital discharge but researchers said this elevated mortality risk persisted regardless of referral to outpatient cardiac referral, receiving activity recommendations or weight management at discharge.

"Eliminating the disparity in cardiac rehabilitation referral by adopting a policy of providing referrals to all cardiovascular patients at hospital discharge could potentially reduce the racial and gender disparity," Li said in a press release.

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