Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality
BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and ResultsWe linked the American Heart Association Get With The Guideli...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.008088 |
| _version_ | 1811332088376328192 |
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| author | Shanshan Li Gregg C. Fonarow Kenneth Mukamal Haolin Xu Roland A. Matsouaka Adam D. Devore Deepak L. Bhatt |
| author_facet | Shanshan Li Gregg C. Fonarow Kenneth Mukamal Haolin Xu Roland A. Matsouaka Adam D. Devore Deepak L. Bhatt |
| author_sort | Shanshan Li |
| collection | DOAJ |
| description | BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral. ConclusionsCR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral. |
| first_indexed | 2024-04-13T16:31:29Z |
| format | Article |
| id | doaj.art-84bfc97f628e431ba55f32dc0b3309c2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:31:29Z |
| publishDate | 2018-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-84bfc97f628e431ba55f32dc0b3309c22022-12-22T02:39:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-04-017810.1161/JAHA.117.008088Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term MortalityShanshan Li0Gregg C. Fonarow1Kenneth Mukamal2Haolin Xu3Roland A. Matsouaka4Adam D. Devore5Deepak L. Bhatt6Boston University School of Medicine, Boston, MAUniversity of California, Los Angeles, CABeth Israel Deaconess Medical Center, Boston, MADuke Clinical Research Institute, Durham, NCDuke Clinical Research Institute, Durham, NCDuke Clinical Research Institute, Durham, NCBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MABackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral. ConclusionsCR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.https://www.ahajournals.org/doi/10.1161/JAHA.117.008088cardiac rehabilitationcardiovascular diseaseepidemiologymortality |
| spellingShingle | Shanshan Li Gregg C. Fonarow Kenneth Mukamal Haolin Xu Roland A. Matsouaka Adam D. Devore Deepak L. Bhatt Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac rehabilitation cardiovascular disease epidemiology mortality |
| title | Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality |
| title_full | Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality |
| title_fullStr | Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality |
| title_full_unstemmed | Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality |
| title_short | Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality |
| title_sort | sex and racial disparities in cardiac rehabilitation referral at hospital discharge and gaps in long term mortality |
| topic | cardiac rehabilitation cardiovascular disease epidemiology mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.008088 |
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