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Disparities in women’s referral to and enrollment in outpatient cardiac rehabilitation

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Abstract

OBJECTIVE: The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs.

DESIGN: Prospective longitudinal design.

SETTING: One large academic medical center and two large community hospitals.

PATIENTS: A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up.

MAIN RESULTS: The rate of referral to outpatients phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P=.03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P=.03). Controlling for age, education, angina class, and comorbidities, women with annual incomes <$20,000 were 66% less likely to be referred to cardiac rehabilitation (P=.01) and 60% less likely to enroll compared to women with incomes >$20,000 (P=.01). Although borderline significant, African-American women were 55% less likely to be referred (P=.059) and 58% less likely to enroll (P=.059) than white women.

CONCLUSIONS: We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities.

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Authors and Affiliations

  1. School of Health Technology and Management, Stony Brook University, New York, NY

    Lisa Benz Scott PhD

  2. Johns Hopkins University School of Medicine, Baltimore, Md

    Kerry J. Stewart EdD

  3. Department of Kinesiology, University of Maryland, College Park, Md

    Deborah Rohm Young PhD

  4. School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Room 304, 21205, Baltimore, MD

    Jerilyn K. Allen RN, ScD, FAAN

Authors
  1. Jerilyn K. Allen RN, ScD, FAAN
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  2. Lisa Benz Scott PhD
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  3. Kerry J. Stewart EdD
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  4. Deborah Rohm Young PhD
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Correspondence to Jerilyn K. Allen RN, ScD, FAAN.

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Allen, J.K., Scott, L.B., Stewart, K.J. et al. Disparities in women’s referral to and enrollment in outpatient cardiac rehabilitation. J GEN INTERN MED 19, 747–753 (2004). https://doi.org/10.1111/j.1525-1497.2004.30300.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30300.x

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