Effect of Cardiac Rehabilitation on South Asian Individuals With Cardiovascular Disease: Results From the APPROACH Registry

Abstract Background Unequivocally, cardiac rehabilitation (CR) in patients with established cardiovascular disease improves survival. However, its effect on higher-risk ethnic groups has not been explored. Accordingly, we evaluated the effect of CR on South Asian (SA) compared with European Canadians with coronary artery disease (CAD). Methods Using the A lberta P rovincial Pr oject for O utcome A ssessment in C oronary H eart Disease (APPROACH) registry, 26,167 patients from Edmonton, Alberta who received coronary angiography with documented CAD were reviewed (January 2002 to March 2012). After excluding Chinese patients, 1027 SA patients were compared with 11,992 European Canadian patients using validated surname algorithms. Adjustment was performed using a Cox proportional hazard model. Results Of the SA cohort, 50.6% attended CR, compared with 43.0% of the European Canadian cohort ( P P P  = 0.045; European population: HR, 0.57; 95% CI, 0.52-0.63; P P P  = 0.02; incomplete CR: HR, 0.78; 95% CI, 0.45-1.35; P  = 0.38). Conclusions Overall, referral rates to CR remains low but attendance appears higher in SA patients. Among those who attended CR, there is a strong association with improved survival irrespective of ethnic status. In SA patients with CAD, attendance and completion of CR should be strongly endorsed because of its incremental benefit.