Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) student Barune Thapa, SM, recently published new research in the Journal of the American Heart Association (JAHA) examining how the neighborhoods where patients live continue to shape their health after a heart attack, even when they participate in an accessible, home-based cardiac rehabilitation program designed to reduce disparities.
Thapa is the lead author of “Neighborhood Disadvantage and Risk of Hospitalization in a Home‐Based Cardiac Rehabilitation Program After Acute Myocardial Infarction: A Retrospective Cohort Study,” published in JAHA in December 2025. The study analyzes outcomes for patients recovering at home after an acute myocardial infarction (heart attack) in Kaiser Permanente’s home-based cardiac rehabilitation program.
Chileshe Nkonde Price, MD, FACC, KPSOM Associate Professor of Clinical Science, served as lead scholarly project mentor and Principal Investigator; other collaborators were Kristi Reynolds, PhD, KPSOM Professor of Health Systems Science; Matthew Medford, PhD, a Research Scientist in the Kaiser Permanente Department of Research & Evaluation; and Mark Duggan, MA, KPSOM Data Analyst.
Thapa said he was inspired by Dr. Price’s earlier work showing that home-based cardiac rehabilitation could be as effective as center-based programs, while expanding access for diverse patients. “But I was honestly a little doubtful that it would be working the same for everybody,” he explained, noting that putting a smartwatch on someone’s wrist does not erase structural barriers such as unsafe streets, lack of sidewalks, or limited access to healthy food.
The study asked if, after a heart attack, does the neighborhood where a patient lives still influence their chances of being hospitalized again, even when they have completed an at-home rehabilitation program meant to narrow gaps in care? The researchers used a census-based multidimensional measure of neighborhood deprivation that incorporates poverty, housing conditions, education, and occupation, grouping patients into four quartiles from most advantaged to most disadvantaged.
Among patients who completed home-based cardiac rehabilitation, those living in the most disadvantaged neighborhoods were about twice as likely to be rehospitalized after their heart attack compared with patients in the most advantaged neighborhoods, the research found. These differences emerged even though all patients received the same structured program, which includes a smartwatch to track exercise, weekly nurse phone calls, and computer-based resources on heart-healthy diet and lifestyle.
For Thapa, the findings highlight the limits of relying solely on clinical interventions to close equity gaps. “While we might be providing more equalizing treatment, it’s not actually equitable treatment,” he said, emphasizing the need for policies and programs that address neighborhood-level barriers such as unsafe environments for exercise and lack of access to affordable, nutritious food.
He described the study as an effort to “answer to the question of how neighborhood continues to influence the risk of hospitalization in those who had a heart attack, even after they’ve been through an accessible home-based cardiac rehabilitation program meant to reduce disparities.” He said he hopes the findings will inform health system efforts to incorporate tools such as patient navigators, community health workers, and social support systems such as food vouchers and safer options for physical activity, into cardiac care pathways.
Thapa’s JAHA publication adds to his growing body of scholarship at the intersection of cardiology, environment, and equity. In March 2026, Dr. Price will share Thapa's work in a moderated poster presentation at the American College of Cardiology (ACC) Scientific Session in New Orleans, discussing how air pollution affects survival after heart attack. It will be the third time Thapa's research has been presented at the ACC’s flagship meeting.
“It is unusual for a medical student to get a poster presentation at the major, premier cardiology conferences,” said Dr. Price. “In my career to date I have never [previously] had a student get to the next level, a moderated poster presentation. Barune has now done this twice.”
Dr. Price recalled that Thapa approached her early in medical school with “an elegant but challenging” question about how unmeasured neighborhood factors might be shaping outcomes in home-based cardiac rehabilitation. She noted that Thapa “embodied exactly the kind of medical students that KPSOM seeks to recruit, aligned fully with [the] mission to challenge the status quo and did this with such rigor and success,” noting his determination to measure structural drivers of health.
