Sex Differences in Cardiac Rehabilitation Outcomes

Abstract

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.

Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta‐analysis

“…The American Heart Association/American College of Cardiology recommends cardiac rehabilitation (CR) for secondary prevention in patients with cardiovascular disease. 30 CR refers to rehabilitation treatment that allows patients with heart disease to live autonomously through specific intervention methods. 31 In 2017, the European Society of Cardiology indicated that all patients with AMI should actively participate in cardiac rehabilitation programs, 32 consisting of appropriate exercise training, lifestyle changes, and weight and nutritional management.…”

“…Therefore, early intervention in patients with AMI can improve the prognosis of patients. The American Heart Association/American College of Cardiology recommends cardiac rehabilitation (CR) for secondary prevention in patients with cardiovascular disease 30 . CR refers to rehabilitation treatment that allows patients with heart disease to live autonomously through specific intervention methods 31 .…”

Predictors of Changes in Peak Oxygen Uptake After Outpatient Cardiac Rehabilitation: Importance of Cardiac Rehabilitation Attendance

“… 14 Despite these beneficial effects of CR attendance on VO 2 peak and mortality, CR attendance is low in the United States with numerous patient, hospital care/provider, and social-/environment-level factors playing a role. 7 , 37 The explanation for the discrepancy in CR attendance on VO 2 peak improvement between the VO 2 peak responder and nonresponder group comparison and multivariable analysis is unclear. However, as multiple clinical factors contribute to VO 2 peak improvement (eg, age, pre-CR VO 2 peak), this may suggest that adjusting for these established clinical variables that are associated with VO 2 peak improvement are necessary to determine whether additional, novel clinical factors contribute to VO 2 peak improvement after CR.…”

“…1 Cardiac rehabilitation (CR), a class 1 recommended therapy for secondary prevention, comprises an interdisciplinary chronic disease management program that has been shown to improve CVD risk factor management, quality of life, and medication adherence and provide group support and counseling. [2][3][4][5][6][7] Importantly, CR participation is associated with reductions in hospital readmissions and mortality in these patients. [8][9][10][11] A crucial component of CR is the prescribed exercise training to elicit improvements in aerobic exercise capacity (ie, peak oxygen uptake [VO 2 peak]).…”

A Scientific Imperative as Seen Through a Sharpened Lens: Sex, Gender, and the Cardiovascular Condition

“…3,[5][6][7][8] Finally, and concerningly, is the consistent finding that available cardiovascular interventions are often not similarly effective in females compared with males, likely due to a combination of factors including sex differences in biological response, gender differences in patterns of prescribing or titrating therapies, and available therapies themselves being functionally inadequate or mismatched for the treatment of femalespecific cardiovascular conditions. [3][4][5][6]10,11 The scientific imperative is now ever clear. Notwithstanding foundational achievements to date, much of what we currently understand about cardiovascular risk in females stems from predominantly descriptive data on sex differences.…”