A Review of Disparities in Cardiac Rehabilitation: EVIDENCE, DRIVERS, AND SOLUTIONS. Issue 6 (November 2021)

• Record Type: Journal Article
• Authors: Mathews, Lena; Brewer, LaPrincess C.
• Is Part Of: Journal of cardiopulmonary rehabilitation and prevention. Volume 41:Issue 6(2021)
• Publication Date: 2021-11
• Subjects: cardiac rehabilitation -- health disparities -- race -- region -- sex -- socioeconomic status; Cardiopulmonary system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Cardiopulmonary system -- Diseases -- Prevention -- Periodicals; 616.103
• DOI: 10.1097/HCR.0000000000000659
• Languages: English
• ISSNs: 1932-7501

Abstract

Abstract : Purpose: Cardiac rehabilitation (CR) has been shown to improve functional status, quality of life, and recurrent cardiovascular disease (CVD) events. Despite its demonstrated compelling benefits and guideline recommendation, CR is underutilized, and there are significant disparities in CR utilization particularly by race, ethnicity, sex, and socioeconomic status. The purpose of this review is to summarize the evidence and drivers of these disparities and recommend potential solutions. Methods: In this review, key studies documenting disparities in CR referrals, enrollment, and completion are discussed. Additionally, potential mechanisms for these disparities are summarized and strategies are reviewed for addressing them. Summary: There is a wealth of literature demonstrating disparities among racial and ethnic minorities, women, those with lower income and education attainment, and those living in rural and dense urban areas. However, there was minimal focus on how the social determinants of health contribute to the observed disparities in CR utilization in many of the studies reviewed. Interventions such as automatic referrals, inpatient liaisons, mitigation of economic barriers, novel delivery mechanisms, community partnerships, and health equity metrics to incentivize health care organizations to reduce care disparities are potential solutions. Abstract : This review describes disparities in utilization of cardiac rehabilitation (CR) by race and ethnicity, sex, and geography. Further, the intersection of social determinants of health on observed disparities based on individual characteristics is described. Despite the proven benefits of CR, significant disparities in patient referrals, enrollment, and completion remain. Relevant literature documenting these disparities, their potential mechanisms, and means for disparity reduction is discussed.