Researchers have found substantial sex and racial disparities in cardiac rehabilitation referrals at hospitals upon discharge, situations they say that lead to lower survival rates. The study, published in the Journal of the American Heart Association, reported that the gaps are especially noticeable among females, African-Americans, Hispanic and Asian patients.
Cardiac rehabilitation is recommended for all eligible patients, regardless of their gender or race yet referral rates at hospital discharge remain low. It is unclear whether inequality in cardiac rehabilitation referral is associated with patients' long-term survival.
Researchers linked the American Heart Association's Get With The Guideline Coronary Artery Disease (CAD) registry with Medicare claims data for 48,993 CAD patients from 365 hospitals across the United States between 2003 and 2009.
They found only 40% of eligible patients received a cardiac rehabilitation referral. Females were 12% less likely to receive cardiac rehabilitation referral compared with males. African-American, Hispanic, and Asian patients were 20, 36, and 50% less likely to receive cardiac rehabilitation referral than white patients.
According to the researchers eliminating inequality in cardiac rehabilitation referral at hospital discharge could potentially reduce long-term mortality. Specifically, 40% for women, 25% for African-Americans, 38% for Hispanics and 375 for Asian patients.
"It is now clear that inequality in cardiac rehabilitation referral practices are associated with patients' long-term survival. Eliminating the disparity in CR referral by adopting a policy of providing referrals to all cardiovascular patients at hospital discharge could potentially reduce the racial and gender disparity," explained corresponding author Shanshan Li, assistant professor of medicine at Boston University School of Medicine.
The researchers believe cardiac rehabilitation referral rates urgently need improvement and that nationally targeted cardiac rehabilitation quality improvement interventions should be supported.