Exploring the reasons for South Asian patients’ attendance and non-attendance at cardiac rehabilitation

Individuals of South Asian ethnic origin have a higher risk of premature death from coronary heart disease (CHD) compared with other ethnic groups; a pattern that has been recorded among South Asians residing in the Indian subcontinent and among South Asian migrants. Established CHD risk factors including hypertension, hypercholesterolemia, diabetes mellitus, smoking and abdominal obesity account for more than 90% of the attributable risk of myocardial infarction (MI), regardless of ethnicity. However, there is evidence that abdominal obesity and insulin resistance, in particular, explain the excess CHD risk observed in South Asian people. It follows that therapeutic strategies likely to confer the greatest benefit to CHD patients of South Asian origin are ones that promote moderate weight loss, regular exercise, and healthful nutrition, such as those offered at comprehensive cardiac rehabilitation (CR) programmes. However, low-levels of CR participation among South Asian and other ethnic minority groups have been reported in several English-speaking countries including the United States, Canada, the United Kingdom and Australia. The purpose of this study will be to explore the reasons for South Asian patients’ attendance and non-attendance at CR with the aim of developing an empirical basis for culturally-competent CR programmes.