Disparities in the Use of Cardiac Rehabilitation after a Myocardial Infarction in the United States.

Kunal S Patel,Joshua D Brown

doi:10.3390/jcm8071006

Kunal S Patel, Joshua D Brown

Open Access

https://doi.org/10.3390/jcm8071006

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Abstract

The study’s aim was to identify disparities in the use of cardiac rehabilitation (CR) services. Data were obtained from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) conducted through landline and cellular phones by the Centers for Disease Control and Prevention. Demographic, behavioral, and clinical variables were defined to explore disparities between CR users and non-users. Bivariate chi-square analyses and weighted multivariable logistic regression were used to identify disparities. Analyses were conducted using SAS version 9.4. There were 8506 individuals who had a myocardial infarction (MI) that completed the survey, and 2891 of these individuals reported using CR. The mean weighted CR utilization rate was 31.9% and varied from 17.9% (Hawaii) to 58.9% (Minnesota). Females (adjusted odds ratio (aOR) = 0.73; 0.6–0.88), African Americans (aOR = 0.63; 0.46–0.87), and those in-between the ages of 18 and 49 years-old were less likely to use CR (aOR = 0.54; 0.34–0.86) compared to their counterparts. Individuals who were high school graduates (aOR = 1.57; 1.19–2.07), attended college (aOR = 1.34; 1.01–1.79), or graduated college (aOR = 1.91; 1.41–2.61) were more likely to use CR compared to their counterparts. Non-high school graduates, females, African Americans, and those aged between 18 to 49 should be targeted to increase CR participation.

Highlights

Each year about 790,000 patients have a myocardial infarction (MI), and of those patients, about 114,000 die from an MI in the United States (US)
Caucasians (35%) are more likely to use cardiac rehabilitation (CR) services compared to African Americans (21.6%), Asians (19.3%), Hispanics (22.8%), and other races (25.4%)
Individuals who are 80 years or older (40.1%) are more likely to use CR services than those who are in the age groups of 60–79 (36.8%) and 18–59 (20.8%)

Summary

Introduction

Each year about 790,000 patients have a myocardial infarction (MI), and of those patients, about 114,000 die from an MI in the United States (US). MIs account for around $11.5 billion in healthcare costs annually. In 2015, there was an estimated annual incidence of about 210,000 recurrent MIs, which accounted for 28.5% of all MIs in the US [1]. Recurrent MI can be overwhelming to patients, due to the high cost of treatment and the increase in mortality and morbidity. After a patient’s initial MI, there is an increased risk of future cardiovascular events, such as recurrent MIs, heart failures, arrhythmias, strokes, and anginas. MI survivors have an increased risk of recurrent MI and a death rate of 5%, which is six times the death rate for patients in the same age group without an MI [2]

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