Secondary prevention outcomes among black and white cardiac rehabilitation patients
Department of Quantitative Health Sciences
Medical Subject Headings
*African Continental Ancestry Group; Comorbidity; Coronary Disease; Diabetes Mellitus; Dyslipidemias; *European Continental Ancestry Group; Exercise; Female; Health Promotion; Humans; Hypertension; Male; Middle Aged; Monitoring, Physiologic; Risk Factors; Sex Distribution; Telemetry; Treatment Outcome; United States
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
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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Citation: Am Heart J. 2007 Jun;153(6):980-6. Link to article on publisher's site