Cardiac Rehabilitation Participation in Underserved Populations

Cardiac rehabilitation (CR) services in the United States are underutilized and participation is particularly low for racial and ethnic minorities, low socioeconomic status patients, and rural residents. Reduced participation may not only indicate a failure in transitional cardiac care during the inhospital referral process but also could be due to barriers attributed to patients, providers, employers, or medical systems. In-depth analysis of this problem is impeded by difficulties with the identification of underserved groups in clinical settings. Disparities in CR participation certainly contribute to poor medical outcomes in these populations that stand to benefit greatly from lifestyle modifications. It is critical that CR providers survey their communities for underserved populations and coordinate creative efforts aimed at overcoming barriers to participation. Moreover, it is likely that referral to, and participation in, CR will soon be considered a quality indicator, providing further incentive for programs to optimize CR utilization among all eligible patients.

[1]  H. Temkin-Greener Medicaid Families Under Managed Care: Anticipated Behavior , 1986, Medical care.

[2]  G. Guyatt,et al.  Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. , 1988 .

[3]  J. Buring,et al.  An overview of randomized trials of rehabilitation with exercise after myocardial infarction. , 1989, Circulation.

[4]  D. Polk,et al.  Referral patterns and exercise response in the rehabilitation of female coronary patients aged ≥62 years , 1992 .

[5]  G. Balady,et al.  Comparison of outcome of cardiac rehabilitation in black women and white women. , 1995, The American journal of cardiology.

[6]  K. Lee,et al.  Importance of baseline functional and socioeconomic factors for participation in cardiac rehabilitation. , 1995, The American journal of cardiology.

[7]  J. Pell,et al.  Retrospective study of influence of deprivation on uptake of cardiac rehabilitation , 1996, BMJ.

[8]  C. Lamendola,et al.  National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns. , 1996, Journal of cardiopulmonary rehabilitation.

[9]  D. B. Friedman,et al.  Compliance and efficacy of cardiac rehabilitation and risk factor modification in the medically indigent. , 1997, The American journal of cardiology.

[10]  W. Rosamond,et al.  Predictors of outpatient cardiac rehabilitation utilization: the Minnesota Heart Surgery Registry. , 1998, Journal of cardiopulmonary rehabilitation.

[11]  D. K. Martin,et al.  Racial disparity in cardiac decision making: results from patient focus groups. , 1998, Archives of internal medicine.

[12]  D. Gray,et al.  Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited , 1999, Heart.

[13]  V. Bittner,et al.  Referral patterns to a University-based cardiac rehabilitation program. , 1999, The American journal of cardiology.

[14]  V. Salomaa,et al.  Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study. , 2000, Circulation.

[15]  I. Piña,et al.  A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring , 2000 .

[16]  P. Ades Cardiac rehabilitation and secondary prevention of coronary heart disease. , 2001, The New England journal of medicine.

[17]  K. Gerrish,et al.  Cardiac rehabilitation: the needs of South Asian cardiac patients. , 2001, British journal of nursing.

[18]  G. Lip,et al.  Predictors of attendance at cardiac rehabilitation after myocardial infarction. , 2001, Journal of psychosomatic research.

[19]  L. Scott,et al.  Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion. , 2002, Journal of women's health.

[20]  S. Saha,et al.  Patient-physician relationships and racial disparities in the quality of health care. , 2003, American journal of public health.

[21]  J. Killian,et al.  Cardiac rehabilitation after myocardial infarction in the community. , 2004, Journal of the American College of Cardiology.

[22]  S. Greenfield,et al.  Attendance of ethnic minority patients in cardiac rehabilitation. , 2004, Journal of cardiopulmonary rehabilitation.

[23]  S. Ebrahim,et al.  Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. , 2004, The American journal of medicine.

[24]  G. Lip,et al.  Heart failure—the importance of ethnicity , 2004, European journal of heart failure.

[25]  D. Curnier,et al.  Geographic distribution of cardiac rehabilitation programs in the United States. , 2005, Journal of cardiopulmonary rehabilitation.

[26]  W Linden,et al.  Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors , 2004, Heart.

[27]  T. Laveist,et al.  Racial Disparities in Access to Cardiac Rehabilitation , 2006, American journal of physical medicine & rehabilitation.

[28]  H. Arthur,et al.  Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review. , 2006, American heart journal.

[29]  R. Hasnain-Wynia,et al.  Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. , 2006, Health services research.

[30]  D. Brooks,et al.  A prospective comparison of cardiac rehabilitation enrollment following automatic vs usual referral. , 2007, Journal of rehabilitation medicine.

[31]  L. Scott,et al.  Disparities in women’s referral to and enrollment in outpatient cardiac rehabilitation , 2004, Journal of General Internal Medicine.

[32]  Sharon-Lise T Normand,et al.  Use of Cardiac Rehabilitation by Medicare Beneficiaries After Myocardial Infarction or Coronary Bypass Surgery , 2007, Circulation.

[33]  R. Chan,et al.  Influence of socioeconomic status on lifestyle behavior modifications among survivors of acute myocardial infarction. , 2008, The American journal of cardiology.

[34]  Kimberly A. Watson,et al.  The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties. , 2008, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[35]  W. Santamore,et al.  Cardiovascular Disease Knowledge and Risk Perception Among Underserved Individuals at Increased Risk of Cardiovascular Disease , 2008, The Journal of cardiovascular nursing.

[36]  Al Ozonoff,et al.  Effect of an American Heart Association Get With the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. , 2008, The American journal of cardiology.

[37]  O. Faergeman,et al.  Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend. , 2008, European journal of public health.

[38]  D. Schneider,et al.  Effect of a Computerized Referral at Hospital Discharge on Cardiac Rehabilitation Participation Rates , 2009, Journal of cardiopulmonary rehabilitation and prevention.

[39]  Li Liang,et al.  Predictors of cardiac rehabilitation referral in coronary artery disease patients: findings from the American Heart Association's Get With The Guidelines Program. , 2009, Journal of the American College of Cardiology.

[40]  D. Shepard,et al.  Costs of Cardiac Rehabilitation and Enhanced Lifestyle Modification Programs , 2009, Journal of cardiopulmonary rehabilitation and prevention.

[41]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2010 update: a report from the American Heart Association. , 2010, Circulation.

[42]  J. Tu,et al.  Heart failure in the ethnic minorities , 2010, Current opinion in cardiology.

[43]  S. Yusuf,et al.  Association of Diet, Exercise, and Smoking Modification With Risk of Early Cardiovascular Events After Acute Coronary Syndromes , 2010, Circulation.

[44]  G. Balady,et al.  The rewards of good behavior. , 2010, Circulation.