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Cardiac Rehabilitation Outcomes by Ethnocultural Background: RESULTS FROM THE CANADIAN CARDIAC REHAB REGISTRY

Findlay, Briar BSc; Oh, Paul MD; Grace, Sherry L. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: September 2017 - Volume 37 - Issue 5 - p 334–340
doi: 10.1097/HCR.0000000000000238
Cardiac Rehabilitation

Background: Patients of diverse ethnocultural backgrounds are underrepresented among participants and, hence, little is known about their outcomes. The objectives of this study were to compare cardiac rehabilitation (CR) utilization, cardiovascular risk factor reduction (blood pressure, lipids, anthropometrics), and functional capacity between white and ethnocultural minority patients participating in CR across Canada.

Methods: The study was a retrospective, observational cohort study using the Canadian Cardiac Rehab Registry (CCRR). Participants from an ethnocultural minority (n ≥ 25) were propensity-matched to white participants based on sociodemographic and clinical characteristics. CR outcomes were compared.

Results: In the CCRR, 3848 (53.8%) participants had an ethnocultural background reported. Of those, whites (n = 3630) and South Asians (n = 26), Southeast Asians (n = 45), and Arab/West Asians (n = 37) minorities had sufficient representation in the registry to be analyzed. In the matched sample, 364 (97.1%) participants completed a discharge assessment. Southeast Asian participants adhered to (96.5%, P = .02) and completed (88.2%, P = .02) CR more often than white participants (90.2% and 55.6%, respectively). Southeast Asian participants had significantly lower diastolic blood pressure (P = .002) at CR discharge than matched white participants. No other differences in outcomes or functional capacity were observed.

Conclusions: Ethnocultural minorities make up a small proportion of CR participants in Canada. However, when they do participate, they achieve similar CR outcomes compared with white participants. CR programs should seek to ensure ethnoculturally diverse patients are referred to their programs and ensure their programs are culturally sensitive to the needs of the preponderant ethnocultural groups in their catchment areas.

Supplemental Digital Content is Available in the Text.Cardiac rehabilitation (CR) utilization, risk factors, and functional capacity between white and ethnocultural minority patients included in the Canadian CR Registry were compared. Southeast Asian participants adhered to and completed CR more often, and had better diastolic blood pressure control than white participants. No other significant differences were observed.

Faculty of Medicine, University of Toronto, Canada (Mr Findlay and Drs Oh and Grace); Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada (Drs Oh and Grace); School of Kinesiology and Health Science, York University, Toronto, Canada (Dr Grace).

Correspondence: Sherry L. Grace, PhD, York University, 368 Norman Bethune, 4700 Keele St, Toronto, ON M3J 1P3, Canada (

All authors have read and approved of the manuscript.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.