Article Text
Abstract
Background Despite evidence supporting cardiac rehabilitation (CR), reduced uptake and completion in ethnic minority service users is reported (NACR, 2023). Multiple ethnicities are grouped together, therefore South Asian uptake and completion is unclear. Little is known about South Asian and White European predictors of CR uptake and completion. Understanding key predictors to participation may assist with equitable resource allocation.
Aim To evaluate likelihood of CR uptake and completion, and assess patient-related predictors of completion in South Asian and White European service users in the UK.
Methods National Audit of Cardiac Rehabilitation (NACR) data w ere used to identify South Asian and White European populations who started core CR between Jan 2014 – Jan 2023. Initiating events included myocardial infarction (MI), percutaneous coronary intervention (PCI/PPCI) and coronary artery bypass (CABG). Logistic regression with stepped adjustment evaluated likelihood of uptake and completion, and backwards stepwise regression assessed patient-related predictors of completion, carried out in StataBE v17.
Results From 490,646 patients eligible for CR, 268,264 started (56%), of which 205,879 (77%) completed. After adjustment for age, sex, index of multiple deprivation (IMD) and number of co-morbidities, South Asian service users were 10% more likely to uptake CR compared to White Europeans, but 17% less likely to complete. Positive predictors of completion across ethnicities included: erectile dysfunction, living in least deprived areas, and 1-2 co-morbidities. Negative predictors included: anxiety, depression, stroke and diabetes. Having > 3 co-morbidities and family history of heart disease were unique predictors for South Asian patients (table 1).
Conclusion Many predictors of CR completion were common across both ethnicities. Services can utilise these predictive factors to provide extra support to those who display negative predictive factors to increase participation.
This is independent research funded by the Wellcome Trust and carried out at the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the Wellcome Trust, the NIHR or the Department of Health and Social Care.
Backwards stepwise logistic regression model showing positive and negative predictors of completing cardiac rehabilitation for White European and South Asian populations