Gender disparities in Cardiac Rehabilitation - Are we concealing apples from Eve?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular disease is a leading cause of death in both men and women and cardiac rehabilitation (CR) is recommended as part of secondary prevention for these patients. Despite this, there are still important asymmetries when it comes to enrolment of women in CR programs. Purpose To determine differences between referral and outcomes of cardiac rehabilitation programs among women. Methods Prospective cohort study which included consecutive pts who were participating in a centre-based CR program lasting 8 weeks from 2019 to 2021. We analyzed prevalence of risk factors, lab echocardiographic and CPET data in women who were enrolled in the program. Statistical analysis was performed with Mann-Whitney and Wilcoxon tests Results: From a total of 349 patients, 60 women completed a CR program – 17,8% of pts – representing a far smaller percentage when accounting to acute coronary syndrome events in our center in those 2 years (31% women). Mean age of female participants was 60 ± 11,8 years; 74% had hypertension, 64% dyslipidemia, 19% diabetes and only 40% had never smoked. There were no significant differences when compared to male, except for thyroid disease which was more frequent among women (p<0.01). Regarding lab data we noticed an improvement of LDL-c, total cholesterol, HDL-c, although only NTproBNP showed a statistically significant reduction (p=0.001). There was also an improvement of LVEF, once again without statistical significance (in contrast to the male population). After completion of the program, there was an improvement regarding CPET duration and workload (p<0.001 and p=0.019). Interestingly there was no difference in terms of peak VO2/kg, a data that goes in line with some reports of less impact of exercise based CR in this parameter in women. Moreover, there were no differences between genders in terms of outcome, namely admissions or cardiovascular death. Conclusion Women still have a lower rate of enrolment in CR programs, despite results showing a similar benefit to men. CR effectiveness by CPET should include other parameters besides VO2 peak. Strategies should be developed to improve women participation in CR.