The Paucity of Data Addressing the Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women

Ghisi, Gabriela Lima de Melo; Chaves, Gabriela; Bennett, Amanda; Lavie, Carl J.; Grace, Sherry L.

doi:10.1016/j.cjca.2017.11.001

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…28 To this point, meta-analyses on the effect of CR on mortality and morbidity in females have not been able to be conducted due to the lack of available CR data in females. 145,146 Recommendations have recently been outlined by Norris et al 4 that range from investing in research training that is focused on sex differences in biomedical science that spans the clinical to translational spectrum to the development and implementation of policies that mandate reporting data by sex and eliminate barriers for the inclusion of females in research studies and clinical trials. Second, there is emerging evidence that suggests that gender, defined here as a psychosocial construct incorporating social norms, expectations, roles, and identities, plays an important role in clinical management and outcomes for patients with CVD.…”

Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

Sex Differences in Cardiac Rehabilitation Outcomes

Smith

Thomas

Bonikowske

et al. 2022

Circulation Research

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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.

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Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

Sex Differences in Cardiac Rehabilitation Outcomes

Smith

Thomas

Bonikowske

et al. 2022

Circulation Research

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“…Meta-analyses on the effect of SP programs on mortality and morbidity in women have not been possible because of the lack of data on women. 54,55 A review of 26 studies of mHealth technology for SP of CVD reported that only four had adequate representation of women. 56 A meta-analysis of digital interventions for risk factor modification in patients with CVD included only 25% women.…”

Section: Discussionmentioning

confidence: 99%

“…First, our trial incorporating smartphone technology for delivering an SP intervention was designed with, and specifically for, women with CHD. Meta-analyses on the effect of SP programs on mortality and morbidity in women have not been possible because of the lack of data on women 54,55. A review of 26 studies of mHealth technology for SP of CVD reported that only four had adequate representation of women 56.…”

Section: Discussionmentioning

confidence: 99%

A Mobile Health Behavior Change Intervention for Women With Coronary Heart Disease

Beckie

Sengupta

Dey

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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C enter-based cardiac rehabilitation (CBCR), the gold standard of secondary prevention (SP) of coronary heart disease (CHD), 1 provides irrefutable health benefits. 2 Support for healthy behavior change is a vital component of contemporary CBCR. 3 However, fewer women than men are referred to CBCR 4,5 and as few as 10-20% of women enroll with up to a 56% noncompletion rate. [6][7][8][9] Welldocumented barriers contribute to the underutilization of CBCR 10 including inadequate health insurance and costly copayments. 11 Women with transportation challenges, less social support, family obligations, depression, or anxiety and women of color are least likely to utilize CBCR. 8,[12][13][14] These barriers have prompted the need to redesign and expand SP alternatives for women. [15][16][17] Individualized SP programs that incorporate sex-specific components hold promise for improving the health behaviors of women. [18][19][20] Moreover, mobile health (mHealth) technology has the potential to increase scalability of SP through broader reach seamlessly in daily life and improved intervention effectiveness. 21 Although technology-enhanced home-based cardiac rehabilitation (CR) offers a possible adjunct to poor CBCR participation, 22 evidence for improved reach and effectiveness for women is limited. 23 Theoretically driven mHealth SP interventions designed specifically for women unable to access CBCR are lacking. 24 Our previously developed gender-specific CBCR 25,26 was translated to a gender-specific mHealth SP behavior change intervention, called HerBeat. Descriptions of the theoretical underpinnings, system architecture, and usability testing of our prototype are found elsewhere. 27,28 HerBeat focuses on improving the health behaviors of women (eg, physical activity [PA], eating behavior, and stress management). Our primary aim was to evaluate, in a randomized controlled pilot study, whether participants in the HerBeat compared with participants in the educational usual care (E-UC) group improved exercise capacity (EC) at 3 mo measured by the 6-min walk test (6MWT). Secondary outcomes included PA, blood pressure (BP), resting heart rate (RHR), body mass index (BMI),

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“…[1][2][3]6 The strengths of this NMA include (1) consideration of setting and dose, (2) the characterization of CR interventions in accordance with Template for Intervention Description and Replication (TIDieR) reporting guidelines, (3) it included non-English trials, (4) they considered depression as an outcome, and (5) they characterized the proportion of males; the latter is important given the paucity of women included in CR trials with hard outcomes. 18,19 The totality of evidence reminds us that great efforts are needed to increase CR efforts worldwide. [1][2][3]6 Even in relatively high-income countries, such as Canada and the United States, the barriers to CR may differ.…”

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confidence: 99%