P3103Cardiac rehabilitation referral after ACS, are women deprived?

Abstract

Abstract 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. Independent predictors for CR referral OR 95% CI p-value Cath 6.5 5.3–8.0 <0.001 STEMI** 3.9 3.3–4.6 <0.001 NSTEMI** 2.1 1.8–2.4 <0.001 Smoker 1.9 1.6–2.1 <0.001 Age* 0.9 0.9–1.0 <0.001 Hypertension 0.8 0.7–0.9 0.023 Prior MI 0.8 0.7–0.9 0.032 Female gender 0.8 0.7–0.9 0.001 Prior CABG 0.7 0.6–0.9 0.003 CVA 0.7 0.6–0.9 0.010 PVD 0.7 0.52–0.9 0.033 CHF 0.7 0.6–0.9 0.001 *Age: continuous; **UA as reference group. 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. Acknowledgement/Funding None