Women, minorities less likely to receive cardiac rehab referrals

Patients with coronary artery disease (CAD) who were referred to cardiac rehabilitation at hospital discharge had a 40 percent decreased risk of all-cause mortality within three years, according to a study published April 6 in the Journal of the American Heart Association. Still, women and minorities were significantly less likely than white men to be referred to this crucial treatment plan.

“As far as we are aware, our study provided the first evidence that inequality in receiving cardiac rehabilitation referral at hospital discharge was associated with patients’ long‐term survival,” wrote lead author Shanshan Li, ScD, an assistant professor of medicine at Boston University, and colleagues. “This information could provide insights on ways to reduce sex and race disparities in cardiovascular health.”

The researchers linked data from a CAD registry with Medicare claims data for 48,993 patients from 365 U.S. hospitals. Overall, cardiac rehab referral was 40 percent during the study period, improving marginally from 34 percent in 2003 to 43 percent in 2009.

Compared to men, women were 12 percent less likely to be referred. Black, Hispanic and Asian patients were 20, 36 and 50 percent less likely, respectively, to be recommended for cardiac rehabilitation (CR) than whites. These findings are despite there being no sex- or race-specific guidelines for cardiac rehab referral; all eligible patients are recommended for the treatment plan.

Importantly, referral was also associated with lower three-year mortality across all of the under-referred groups, with risk reductions ranging from 25 to 39 percent. In addition, the authors calculated that 7 percent of the black-white mortality gap among CAD patients could be closed with equitable referral rates.

“We showed that CR referral at hospital discharge was significantly associated with reduced mortality for women and minorities, a group of patients that have traditionally being understudied in the literature,” Li et al. wrote. “Prior studies suggested that the most significant predictor and easily overcome barrier is the lack of CR referral at hospital discharge. We expanded upon prior study by assessing the degree to which the mortality disparity could be reduced by reducing inequality in CR referral at hospital discharge.”

A primary limitation of the study was it only included hospital data through 2009. Referral rates may have changed since then, the researchers acknowledged, prompting the need for additional research of more recent years.