Health Inequalities in Cardiac Rehabilitation: A National Cohort Study in England

BACKGROUND: Participation in cardiac rehabilitation (CR) by ethnic minorities is poor, despite evidence supporting its effectiveness. This study evaluated CR participation and completion by South Asian compared to White European service users, and assessed factors associated with non-completion in both groups. METHOD: The National Audit of Cardiac Rehabilitation (NACR) data (January 2014 to February 2023) was used to identify South Asian and White European service users referred for CR following myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Logistic regression and backwards selection were used to examine differences in participation and completion between groups and identify associated factors. FINDINGS: From 421,281 service users eligible for CR (383,833 White European, 37,448 South Asian, 115,812 women, median age 67 years), 222,928 participated (53%), of which 171,297 (77%) completed. After adjustment for age, sex, index of multiple deprivation (IMD) and co-morbidities, South Asian service users were 12% more likely to participate in CR than White Europeans (aOR 1.12, 95% CI 1.09 to 1.15), but 22% less likely to complete (aOR 0.78, 95% CI 0.75 to 0.82). In both groups, strongest associations with non-completion were higher deprivation, diabetes and being single. In White European and South Asian men, stroke and depression were also key factors. Non-completion was also associated with respiratory conditions in White Europeans and with rheumatism and family cardiovascular history in South Asian men. INTERPRETATION: South Asians are more likely to participate but less likely to complete CR than White Europeans. Programmes tailored to individual needs are required to reduce disparities in care.