Author + information
- Jillian Colbert,
- Billie-Jean Martin,
- Trina Hauer,
- Mark Haykowsky,
- Leslie Austford,
- Ross Arena,
- Merril Knudtson,
- Don Meldrum,
- Sandeep Aggarwal and
- James Stone
Cardiac rehabilitation (CR) is a proven method of secondary prevention in coronary artery disease (CAD) patients. Several small studies have shown that women are less likely to be referred to and attend CR. Our study examines sex differences in the referral rates, attendance patterns and mortality in a large, well described CAD population.
The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) database was used to obtain information on all patients. Rates of referral to and attendance at CR were compared by sex. Logistic regression models were constructed to assess whether sex predicted CR referral or attendance. Initial models were unadjusted, and subsequent models were adjusted for all demographic and clinical characteristics. The association between referral, attendance and survival was assessed by sex using Cox proportional hazard models.
A total of 25,958 subjects with at least one vessel CAD were included; of those, 6374 (24.6%) were female. Female sex was associated with reduced rates of referral (31.1% vs 42.2% of men (p<0.0001), and reduced rates of attendance (50.1 vs 60.4%, p<0.0001). Relative to male subjects, women were older (mean age 67.3 vs 62.7), and had a higher prevalence of heart failure and diabetes (all p<0.0001). Female sex was associated with reduced rates of referral to CR (adjusted Odds Ratio (OR) 0.74, 95% CI 0.69, 0.79) and reduced rates of attendance (adjusted OR 0.73, 95% CI 0.66, 0.81). Relative to those not referred, women who were referred but did not attend had improved survival (HR 0.78, 95% CI 0.66, 0.92), and those who were referred to CR and attended had the greatest reduction in mortality (HR 0.34, 95% CI 0.27, 0.44). The degree of benefit was greater in women than men.
Despite the fact that women derive greater benefit from attending CR than men, they are less likely to be referred and less likely to attend. Greater emphasis needs to be placed on improving referral and attendance at CR thereby positively impacting the quality of care and decreasing mortality in women with CAD.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Cardiac Rehabilitation – Keys to Improving Cardiovascular Outcomes
Abstract Category: 26. Prevention: Rehabilitation
Presentation Number: 1188-23
- 2013 American College of Cardiology Foundation