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Cardiac rehabilitation referral after ACS, are women deprived?

Session Cardiopulmonary exercise and rehabilitation

Speaker Jacob Klein

Event : ESC Congress 2019

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Moderated Posters

Authors : J Klein (Jerusalem,IL), R Farkash (Jerusalem,IL), F Bayya (Jerusalem,IL), L Taha (Jerusalem,IL), N Abeles (Jerusalem,IL), A Kischner (Jerusalem,IL), E Yaacobi (Jerusalem,IL), M Glikson (Jerusalem,IL)

Authors:
J. Klein1 , R. Farkash1 , F. Bayya1 , L. Taha1 , N. Abeles1 , A. Kischner1 , E. Yaacobi1 , M. Glikson1 , 1Shaare Zedek Medical Center, Cardiology - Jerusalem - Israel ,

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 1873

Background: Referral and participation rates to Cardiac Rehabilitation (CR) after acute coronary syndrome (ASC) are low despite a Class I recommendation in the present guidelines. Our aim was to examine the role of gender on referral, participation and outcomes of CR.

Methods: Data of ACS patients hospitalized during 2007–2016 in our cardiology department were extracted and compared between referred to CR to those who were not. Multivariable models were used to assess the impact of gender on referral to CR and survival.

Results: Of the 6175 ACS patients, 1455 (23.6%) were female. Overall referral rate to CR was 66.5%, 51.3% among female and 70.0% in male; p<0.0001.

Female were more likely to have characteristics associated with lower referral rate; they were older, had lower rates of STEMI and higher rates of cardiac risk factors. Multivariable model, adjusted for those characteristics revealed that female gender is independently associated with lower referral rate to CR: OR = 0.77 95% CI [0.66–0.89]; p<0.0001. (Table 1)

Multivariable COX analysis showed that patients referred to CR had lower mortality hazard – HR = 0.427 95% CI [0.35–0.53]; p<0.0001, with no gender difference – HR=1.04 95% CI [1.04–1.06]; p=0.640.

Participation rate within referred patients, program duration as well as number of meetings were similar in female and male p=NS for all.

Conclusions: Referral of ACS patients to CR significantly lowers mortality rate. Referral rate of women to CR is significantly lower than men. Once referred to CR, no gender difference was found in CR participation rate and program compliance.

Independent predictors for CR referral
OR95% CIp-value
Cath6.55.3–8.0<0.001
STEMI**3.93.3–4.6<0.001
NSTEMI**2.11.8–2.4<0.001
Smoker1.91.6–2.1<0.001
Age*0.90.9–1.0<0.001
Hypertension0.80.7–0.90.023
Prior MI0.80.7–0.90.032
Female gender0.80.7–0.90.001
Prior CABG0.70.6–0.90.003
CVA0.70.6–0.90.010
PVD0.70.52–0.90.033
CHF0.70.6–0.90.001
*Age: continuous; **UA as reference group.

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