Cardiovascular and Risk Factor Outcomes for Ethnic Minorities From Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

Abstract

Purpose: To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.

Review methods: We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.

Summary: Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.