Culturally tailored cardiac rehabilitation is required in Australia to address disparities, as Indigenous populations experience cardiac-related hospitalisation at nearly twice the rate of others.
There is a critical need for culturally tailored cardiac rehabilitation programs co-designed with communities to address cardiovascular health disparities among underserved populations in Australia.
Cardiovascular disease (CVD) remains a leading cause of mortality in Australia, disproportionately affecting underserved and priority populations such as Aboriginal and Torres Strait Islander peoples, migrants and refugees, and those from socioeconomically disadvantaged backgrounds (Australian Bureau of Statistics 2019; Walsh and Kangaharan 2016). Despite well-established evidence on the benefits of cardiac rehabilitation (CR) in reducing recurring cardiac events, improving quality of life and lowering mortality, access to and participation in CR remains alarmingly low among these groups (Thompson et al. 2009). A significant contributor to this disparity is the lack of culturally tailored programmes that address the unique needs, preferences and lived experiences of the diverse populations (Bulto and Hendriks 2025). The current CR model in Australia is often delivered in clinical settings and designed around assumptions of cultural homogeneity. This one-size-fits-all approach overlooks the diverse cultural, linguistic and structural barriers faced by priority populations. Migrants and refugees may contend with language difficulties, unfamiliarity with the healthcare system, stigma and cultural beliefs that influence health seeking behaviour (Bulto 2024). Indigenous Australians often face historical and ongoing mistrust in health care institutions and limited access to culturally safe care (Nolan-Isles et al. 2021). Cardiac rehabilitation programmes that fail to incorporate cultural norms are not accessible. Underutilisation of CR services by these populations perpetuates health disparities. For instance, Aboriginal and Torres Strait Islander peoples experience cardiac-related hospitalisation at nearly twice the rate of non-Indigenous Australians and are significantly less likely to attend CR (Australian Bureau of Statistics 2019; Brown 2012). Similarly, culturally and linguistically diverse (CALD) populations face a disproportionate burden of risk factors such as diabetes, hypertension and physical inactivity and have lower rate of CR enrolment and completion. Neglecting these disparities results in increasing premature death, healthcare utilisation and lost productivity. Evidence indicates that culturally tailored CR interventions codesigned with communities and delivered in accessible, linguistically appropriate and culturally relevant ways can significantly improve engagement and outcomes (Joo and Liu 2021). Community-based and home-based CR models, the involvement of bicultural health professionals, and incorporation of traditional health practices and values have shown promise in small scale studies. However, such approaches remain underutilised, poorly funded and inconsistently implemented across Australia. There is a pressing need for health systems to invest in the development, evaluation and scaling up of culturally appropriate CR programmes, guided by meaningful community engagement. Addressing this inequity requires systemic change. First, policy frameworks and funding mechanisms must prioritise equity in cardiac care by mandating the inclusion of culturally appropriate services in CR models. Second, health services must commit to co-designing CR programmes with priority populations, ensuring cultural safety and relevance from the outset. Third, capacity-building efforts are needed to train healthcare providers in cultural competence and to support the recruitment and retention of bicultural and Indigenous health workers. Finally, rigorous research and evaluation must underpin the development of these interventions, ensuring they are both effective and scalable. Nurses play a central role in providing culturally tailored cardiac rehabilitation for culturally and linguistically diverse populations by ensuring care is responsive to patients' cultural, linguistic and social needs. This role encompasses conducting culturally sensitive assessments, adapting health education to align with patients' beliefs, values and health literacy levels, and facilitating effective communication through the appropriate use of professional interpreters and culturally appropriate resources. Nurses are also instrumental in fostering trust, promoting patient engagement and supporting shared decision-making, which are critical for sustained participation in rehabilitation programmes. Additionally, nurses act as advocates and care coordinators, working collaboratively with multidisciplinary teams and community stakeholders to identify and address systemic and contextual barriers to access and continuity of care. Through these roles, nurses contribute to improving adherence, self-management and rehabilitation outcomes, while advancing equity and reducing cardiovascular health disparities among underserved populations. Healthcare leaders, researchers, policy makers and funding bodies in Australia have the responsibility and moral imperative to act. Ensuring equitable access to cardiac rehabilitation for all Australians is not only a matter of providing health service, but also a matter of ensuring equity. Without culturally tailored CR programmes, the health system will continue to leave behind those who need care the most. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Lemma N Bulto (Wed,) conducted a editorial in Cardiovascular disease. Culturally tailored cardiac rehabilitation was evaluated. Culturally tailored cardiac rehabilitation is required in Australia to address disparities, as Indigenous populations experience cardiac-related hospitalisation at nearly twice the rate of others.