Disparities in Cardiac Rehabilitation Among Individuals from Racial and Ethnic Groups and Rural Communities—A Systematic Review

  • Luis R. CastellanosEmail author
  • Omar Viramontes
  • Nainjot K. Bains
  • Ignacio A. ZepedaEmail author
Perspective Article



Despite the well-described benefits of cardiac rehabilitation (CR) on long-term health outcomes, CR is a resource that is underutilized by a significant proportion of patients that suffer from cardiovascular diseases. The main purpose of this study was to examine disparities in CR referral and participation rates among individuals from rural communities and racial and ethnic minority groups with coronary heart disease (CHD) when compared to the general population.


A systematic search of standard databases including MedlLine, PubMed, and Cochrane databases was conducted using keywords that included cardiac rehabilitation, women, race and ethnicity, disparities, and rural populations. Twenty-eight clinical studies from 1990 to 2017 were selected and included 478,955 patients with CHD.


The majority of available clinical studies showed significantly lower CR referral and participation rates among individuals from rural communities, women, and racial and ethnic groups when compared to the general population. Similar to geographic region, socioeconomic status (SES) appears to directly impact the use of CR programs. Patients of lower SES have significantly lower CR referral and participation rates than patients of higher SES.


Data presented underscores the need for systematic referrals using electronic health records for patients with CHD in order to increase overall CR referral and participation rates of minority populations and other vulnerable groups. Educational programs that target healthcare provider biases towards racial and ethnic groups may help attenuate observed disparities. Alternative modalities such as home-based and internet-based CR programs may also help improve CR participation rates among vulnerable populations.


Cardiac rehabilitation Race and ethnicity Rural communities Socioeconomic status Health disparities 



The authors would like to thank UC San Diego, Division of Cardiovascular Medicine and Mrs. Blanca Barba for general administrative assistance. LRC also wishes to acknowledge with tremendous gratitude Mrs. Lizzette Herrera esquire and LLC.


This research did not receive any specific financial support from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  1. 1.Department of MedicineThe University of California San Diego, School of MedicineLa JollaUSA
  2. 2.The University of California San Diego Division of Cardiovascular Medicine and Sulpizio Family Cardiovascular CenterLa JollaUSA
  3. 3.The University of California San Diego, Altman Clinical and Translational Research InstituteLa JollaUSA
  4. 4.The University of California Los AngelesGeffen School of MedicineLos AngelesUSA
  5. 5.Department of MedicineAlbert Einstein College of Medicine, Jacobi Medical CenterBronxUSA

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