Key result
Cardiac rehab yields ~7-meter smaller walk distance gains in South Asian vs. Caucasian patients.
Why the study?
South Asians have a greater predisposition to cardiac events than Caucasians, but data are sparse regarding the benefits acquired by South Asians versus Caucasians in cardiac rehabilitation programs.
Do South Asian patients have different clinical measures and outcomes compared to Caucasian patients when attending cardiac rehabilitation programs?
Cohort (n=7,390)
No
Do South Asian patients have different clinical measures and outcomes compared to Caucasian patients when attending cardiac rehabilitation programs?
South Asian patients attending cardiac rehabilitation programs appear to derive less functional benefit and have lower participation rates compared to Caucasian patients, despite similar use of evidence-based pharmacotherapy.
South Asian patients may derive less functional benefit from cardiac rehabilitation; hypothesis-generating and should not yet change practice.
BackgroundSouth Asians have a greater predisposition to cardiac events, compared to Caucasians. Although cardiac rehabilitation programs (CRPs) are known to improve outcomes, data are sparse regarding benefits acquired by South Asians vs Caucasians. The objective of the current study was to determine the outcomes of South Asian patients undergoing CRPs, compared to Caucasian patients.MethodsThis study compared baseline characteristics and outcomes in all patients attending a CRP in Edmonton, Canada with a proportionately large South Asian population.ResultsFrom 1998 to 2016, a total of 811 South Asians and 5406 Caucasians attended CRPs. Baseline characteristics revealed that there were more nonsmokers (73.4% vs 29.4%, P < 0.001), with a lower body mass index (26.8 ± 0.1 vs 29.6 ± 0.1, P < 0.001), but higher prevalence of diabetes (37.7% vs 20.5%, P < 0.001) in the South Asian population. Outcome measures revealed that South Asians spent less time in the CRP (6.9 weeks ± 0.1 vs 7.3 weeks ± 0.1, P < 0.001), attended the nutrition class less (36.2% vs 53.4%, P < 0.001), and had a lower 6-minute walk improvement (66.9 m vs 73.6 m, P < 0.001). Frequency of use of β-blockers (86.9% vs 86.1%, P > 0.05), antiplatelet agents (96.3% vs 97.1%, P > 0.05), angiotensin-converting enzyme inhibitors (79.9% vs 80.0%, P > 0.05), and cholesterol-lowering agents (91.4% vs 93.8%, P > 0.05) was not significantly different.ConclusionsAlthough South Asians seem to be prescribed and use proven pharmacologic treatments to the same extent as Caucasians, they appeared to benefit less from CRPs. Given higher event rates in South Asians, consideration should be given to altering the delivery of CRPs to South Asians to improve their efficacy.
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Nanayakkara et al. (2021) conducted a cohort in Cardiovascular disease (n=7,390). South Asian ethnicity vs. Caucasian ethnicity was evaluated on Improvement in 6-minute walk distance post-CRP (p=< 0.001). South Asian patients attending a cardiac rehabilitation program experienced a significantly lower improvement in 6-minute walk distance compared to Caucasian patients (66.9 m vs 73.6 m).
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