Disparities in Cardiac Rehabilitation Participation in the United States: A SYSTEMATIC REVIEW AND META-ANALYSIS.
OBJECTIVE
Phase 2 cardiac rehabilitation (CR) is a class I recommendation for all patients following an acute cardiac event or cardiac surgery according to the The American Heart Association and the American College of Cardiology Foundation. Studies have shown that there are differences in cardiac rehabilitation participation rates between sociodemographic groups. The purpose of this systematic review and meta-analyses was to synthesize quantitative data on the relationship between outpatient cardiac rehabilitation (OCR) attendance and various sociodemographic factors.


METHODS
We conducted a search of PubMed, PsycINFO, CINAHL, Google Scholar, Dissertations & Theses A&I, and conference abstracts for observational studies conducted in the United States that fit our inclusion criteria. A total of 21 studies were included in our final review and meta-analyses.


RESULTS
Our meta-analyses showed that overall, attenders were younger than nonattenders (mean difference=-3.74 years, 95% CI =-5.87 to -1.61) and the odds of participation were lower among females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees were more likely to participate than those not employed (OR = 1.45; 95% CI = 1.08-1.95).


CONCLUSIONS
Our systematic review and meta-analyses showed that there are significant sociodemographic disparities in CR participation. On the basis of this knowledge, clinicians and policy makers should focus on identifying and eliminating barriers to participation.
Internal Medicine Resident Physician (Dr Sun), University of North Carolina, Chapel Hill, North Carolina; New Jersey Medical School (Dr Halperin), School of Public Health, Newark Campus (Dr Halperin), and School of Nursing, Newark Campus (Dr Jadotte); Northeast Institute for Evidence Synthesis and Translation, School of Nursing (Dr Jadotte), Rutgers University, Newark, New Jersey; Department of Family, Population and Preventive Medicine (Dr Jadotte), Stony Brook University; Stony Brook, New York.
Enid Y
EY
Sun
Yuri T
YT
Jadotte
William
W
Halperin
D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States