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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Secondary prevention outcomes among black and white cardiac rehabilitation patients
Bonnie K Sanderson1, Saema Mirza, Rachel Fry
1Division of Cardiovascular Disease, Preventive Cardiology, University of Alabama at Birmingham, AL 35294, USA. bsanderson@uabmc.edu
Insights
Black patients in cardiac rehabilitation (CR) had worse risk factors than white patients. While both groups improved, white patients showed greater gains in secondary prevention outcomes, highlighting persistent racial disparities in CR effectiveness.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Coronary heart disease (CHD) risk factors disproportionately affect Black populations.
- The impact of cardiac rehabilitation (CR) on narrowing the racial gap in risk factor control remains unclear.
- This study compared baseline characteristics and secondary prevention outcomes between Black and White CR patients.
Purpose of the Study:
- To compare baseline characteristics of Black and White patients undergoing cardiac rehabilitation.
- To evaluate secondary prevention outcomes and assess the impact of race on these outcomes.
- To determine if CR effectively narrows the gap in risk factor control between racial groups.
Main Methods:
- Retrospective analysis of patient records (n=616) from January 1996 to June 2006.
- Comparison of baseline characteristics and changes in secondary prevention measures during CR between Black and White patients.
- General linear regression modeling to assess the effect of race/ethnicity on CR outcomes, adjusting for covariates.
Main Results:
- Black patients presented with higher rates of hypertension, diabetes, and poorer control of blood pressure, lipids, and HbA1c at baseline.
- While both groups improved, White patients demonstrated significantly greater improvements in 6-minute walk distance, physical activity, BMI, waist circumference, LDL-C, and HbA1c.
- Improvements were less pronounced for Black patients, particularly in measures like HDL-C, BMI, waist circumference, and HbA1c (in diabetic patients).
Conclusions:
- Black patients enter CR with a higher burden of adverse cardiovascular risk factors compared to White patients.
- Despite achieving some secondary prevention benefits, the magnitude of improvement was less for Black patients than White patients.
- These findings underscore persistent racial disparities in the effectiveness of CR, with Black women experiencing particularly diminished benefits.
Background:
Disparities in coronary heart disease and related risk factors persist. It is unknown if cardiac rehabilitation (CR) narrows the gap in risk factor control between black and white patients. Thus, we compared baseline characteristics and secondary prevention outcomes between black and white CR patients.
Methods:
Data from patient records (n = 616, mean age 62 +/- 10 years, 29% women, 25% black) collected between January 1996 and June 2006 were examined. Comparisons were made between Blacks and Whites for baseline characteristics, changes in secondary prevention measures during CR, and the proportion of patients at treatment goals before and after CR. General linear regression modeling was used to determine the effect of race/ethnicity on outcomes.
Results:
At baseline, Blacks had more hypertension and diabetes and more adverse measures for blood pressure, low-density lipoprotein and non-high-density lipoprotein cholesterol (non-HDL-C), hemoglobin A1c, 6-minute walk distance, and Short-Form Health Survey (SF-36) physical component score. At CR completion, improvement (P < .05) was achieved among whites in all measures except for HDL-C and systolic blood pressure. Among Blacks, improvement did not reach significance for HDL-C, body mass index, waist circumference, and hemoglobin A1c (when diabetes was present). When adjusting for age, gender, number of sessions attended, and baseline measure, Whites improved more than Blacks in 6-minute walk distance, self-reported physical activity, body mass index, waist circumference, low-density lipoprotein cholesterol, and hemoglobin A1c (all P < .05).
Conclusion:
Blacks entered CR with more adverse risk factor measures compared with Whites. Although both groups gained secondary prevention benefits, the degree of improvement was less for Blacks than Whites, and this was especially evident among black women.
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