Secondary Prevention Recommendation Attainment with Cardiac Rehabilitation: Is There a Gender Disparity?

Turk-Adawi, Karam; Oldridge, Neil; Vitcenda, Mark; Tarima, Sergey; Grace, Sherry L.

doi:10.1016/j.whi.2016.03.004

Cited by 13 publications

(28 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, studies investigating sex differences in lipid management during CR have included patients primarily when the AHA/ACC lipid management guidelines recommended an LDL-C target goal of <100 mg/dL using statin therapy (<70 mg/dL for high-risk patients). 77–79 Approximately 50 to 65% of patients met this LDL-C target goal at CR entry, with large cohort studies (n=8929–117 913) reporting that LDL-C decreased by 14 to 35 mg/dL (reductions of ≈15%–36%) following CR 78,79,106 (with smaller cohort studies reporting smaller or no changes in LDL-C 95–97,99,108,109 ). At CR entry, females were less likely to be at the LDL-C target goal compared with males and are reported to have a lower or similar frequency of meeting the LDL-C target goal at CR completion than males.…”

Section: Sex Differences In the Core Components Of Crmentioning

confidence: 99%

“…79 Sex differences in blood pressure management during the CR program have been minimally investigated compared with other core components. 79,95,96,116,117 In the study by Turk-Adawi et al, 79 significant (albeit small) reductions in systolic blood pressure in females (−1.6 mm Hg), but not males were found following CR, while both groups exhibited similar reductions in diastolic blood pressure (−0.5 to 1 mm Hg). The minimal reductions in blood pressure with CR may be reflective of a large proportion of patients already meeting the blood pressure AHA/ACC Secondary Prevention goals before CR entry with no sex differences present in the frequency of patients meeting these goals following CR 79 (>90% for males and females for systolic and diastolic blood pressure at CR completion 78,79 ).…”

Section: Sex Differences In the Core Components Of Crmentioning

confidence: 99%

See 1 more Smart Citation

Sex Differences in Cardiac Rehabilitation Outcomes

Smith

Thomas

Bonikowske

et al. 2022

Circulation Research

View full text Add to dashboard Cite

Cardiovascular disease is a leading cause of morbidity and mortality in males and females in the United States and globally. Cardiac rehabilitation (CR) is recommended by the American Heart Association/American College of Cardiology for secondary prevention for patients with cardiovascular disease. CR participation is associated with improved cardiovascular disease risk factor management, quality of life, and exercise capacity as well as reductions in hospital admissions and mortality. Despite these advantageous clinical outcomes, significant sex disparities exist in outpatient phase II CR programming. This article reviews sex differences that are present in the spectrum of care provided by outpatient phase II CR programming (ie, from referral to clinical management). We first review CR participation by detailing the sex disparities in the rates of CR referral, enrollment, and completion. In doing so, we discuss patient, health care provider, and social/environmental level barriers to CR participation with a particular emphasis on those barriers that majorly impact females. We also evaluate sex differences in the core components incorporated into CR programming (eg, patient assessment, exercise training, hypertension management). Next, we review strategies to mitigate these sex differences in CR participation with a focus on automatic CR referral, female-only CR programming, and hybrid CR. Finally, we outline knowledge gaps and areas of future research to minimize and prevent sex differences in CR programming.

show abstract

Section: Sex Differences In the Core Components Of Crmentioning

confidence: 99%

Section: Sex Differences In the Core Components Of Crmentioning

confidence: 99%

Sex Differences in Cardiac Rehabilitation Outcomes

Smith

Thomas

Bonikowske

et al. 2022

Circulation Research

View full text Add to dashboard Cite

show abstract

“…Indeed, even in the general population, participation in secondary prevention behaviors can be very low. For example, in one study of a population that had enrolled in a CR/secondary prevention program, adherence to some of the secondary prevention guidelines was as low as 15% (PA) (51). However, given existing health disparities, improving adherence in lower-SES populations should be a priority.…”

Section: Discussionmentioning

confidence: 99%

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Gaalema

Elliott

Morford

et al. 2017

Progress in Cardiovascular Diseases

View full text Add to dashboard Cite

Introduction Failure to change risk behaviors following myocardial infarction (MI) increases the likelihood of recurrent MI and death. Lower-socioeconomic status (SES) patients are more likely to engage in high-risk behaviors prior to MI. Less well known is whether propensity to change risk behaviors after MI also varies inversely with SES. Methods We performed a systematized literature review addressing changes in risk behaviors following MI as a function of SES. Results 2160 abstracts were reviewed and 44 met eligibility criteria. Behaviors included smoking cessation, cardiac rehabilitation (CR), medication adherence, diet, and physical activity (PA). For each behavior, lower-SES patients were less likely to change after MI. Overall, lower-SES patients were 2 to 4 times less likely to make needed behavior changes (OR's 0.25–0.56). Conclusion Lower-SES populations are less successful at changing risk behaviors post-MI. Increasing their participation in CR/secondary prevention programs, which address multiple risk behaviors, including increasing PA and exercise, should be a priority of healthy lifestyle medicine (HLM).

show abstract

“…Gender disparity was investigated in a study on 12,976 patients of which 69% completed a cardiac rehabilitation program. They reported that both men and women greatly improved but women were less likely to reach target goals of the American Heart Association/American College of Cardiology (AHA/ACC) in serum triglyceride levels and HbA1c, while they were more likely to achieve them for HDL-C. No gender differences were observed regarding achieving AHA/ACC goals of BP, total cholesterol, LDL-C, BMI, smoking cessation, and medication use [34].…”

Section: Changes Observed After Completion Of the Programmentioning

confidence: 99%

Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program

2020

View full text Add to dashboard Cite

Background: Cardiac rehabilitation programs reduce cardiovascular events and mortality in ischemic heart disease patients. The aim of this study was to assess gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program regarding adherence to the program, as well as, changes in clinical, laboratory, and echocardiographic parameters. Results: A prospective study that included 30 men and 30 women with stable ischemic heart disease who had been totally revascularized by percutaneous coronary intervention. Patients were enrolled in a 12-week cardiac rehabilitation program. Assessment of demographics, anthropometric measurements, risk factors, and functional capacity was performed. Lipid profile, glycated hemoglobin, and left ventricular ejection fraction were assessed. Assessments were performed at baseline and after completion of the program. Time to enrollment in the program was prolonged for women 39.17 ± 40.49 vs. 19.77 ± 10.26 days (p = 0.014). At baseline, more women were diabetic (p = 0.004), hypertensive (p = 0.02), had a larger waist circumference (p = 0.022), a higher BMI (p = 0.011), and higher HbA1c (p = 0.033). More men were active smokers (p < 0.001). After completion of the program, it was found that men attended 19.1 ± 4.77 (79.6%) sessions compared to 15.7 ± 5.72 (65.4%) sessions for women (p = 0.015). Women had more reduction in diastolic BP − 10.93 ± 8.94 vs. − 5.47 ± 12.57 mmHg (p = 0.058). The magnitude of reduction in resting heart rate was significant in men (p = 0.018) but not in women (p = 0.376). The magnitude of reduction in serum total cholesterol and triglycerides was more in men (p = 0.018 and p = 0.014). Women showed more reduction in HbA1c (p = 0.052). Conclusion: Men are more adherent to cardiac rehabilitation programs. Recruitment of women is significantly delayed. Women have a higher cardiovascular risk burden in the form of prevalence of diabetes, hypertension, and obesity. Completion of a cardiac rehabilitation program causes a reduction in BMI, waist circumference, blood pressure measurements, total cholesterol, triglycerides, LDL-C, HDL-C, HbA1c, and LVEDD with an increase in LVEF in both genders. Men show more reduction in resting HR, total cholesterol, and triglyceride levels while women show more reduction in diastolic BP and HBA1c.

show abstract

Secondary Prevention Recommendation Attainment with Cardiac Rehabilitation: Is There a Gender Disparity?

Abstract: Men and women generally improved similarly in terms of AHA/ACC goal achievement. Quality improvement strategies need to focus on physical activity and blood glucose control in women.

Cited by 13 publications

References 38 publications

Sex Differences in Cardiac Rehabilitation Outcomes

Sex Differences in Cardiac Rehabilitation Outcomes

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program

Contact Info

Product

Resources

About