Disparities in the rates of referral and subsequent
enrollment in outpatient cardiac rehabilitation can be
linked to income and race, according to a study published
in the July issue of The Journal of General Internal
Medicine. The study, led by Jerilyn K. Allen, associate
dean for research at the Johns Hopkins
School of Nursing,
showed lower outpatient cardiac rehabilitation referral and
enrollment rates — post acute coronary events —
for low-income and African-American women.
A total of 253 women, 108 African-American and 145
white, were surveyed within one month of discharge from
three major hospitals serving Baltimore City and its
surrounding counties. Only 44 (19 percent) self-reported
receiving a health care professional's referral to cardiac
rehabilitation. Low-income (less than $20,000 annual
income) participants were 66 percent less likely to have
received a referral than those of higher incomes, and the
reported rate of referral was lower for African-American
women (12 percent) versus white women (24 percent). Only 15
percent of all women — nine African-American and 26
white — reported enrollment in rehabilitation.
Among the most common reasons cited by patients for
not entering rehabilitation programs — particularly
by African-American women — was the lack of a
referral or follow-up after discharge. Other reasons
included feeling too sick, believing that they either did
not need rehabilitation or could exercise on their own or
being too busy to attend. More than half (51 percent) of
the women knew nothing about cardiac rehabilitation.
Transportation and cost were not cited as barriers to
enrollment.
The study, one of the largest women-only examinations
of potential disparities by race in cardiac rehabilitation
referral and rehabilitation, confirms trends that have been
observed in studies that included a predominance of white
and male patients. Lead researcher Allen noted, "As we have
found in other studies, a referral or recommendation from a
health professional remains a consistently important
predictor of enrollment in cardiac rehabilitation. The good
news in our study is that the majority (80 percent) of our
participants who received information about cardiac
rehabilitation from a health care professional also
reported enrolling.
"This research and future studies can improve our
success rate," Allen said. "When we understand the reasons
why low-income and African-American women seem to receive
less aggressive referral and participate less often in
programs, we can propose the solutions."
The study was co-authored by Lisa Benz Scott, Kerry J.
Stewart and Deborah Rohm Young and was supported with
funding from the Centers for Disease Control and
Prevention.
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