The effects of cardiovascular rehabilitation in patients with heart failure with reduced ejection fraction - does gender really matter?

Abstract

Abstract Background The prevalence of heart failure (HF) in the adult population appears to be 1-2%, and it rises with age. About ½ of HF patients have reduced ejection fraction (HFrEF). Although the positive effects of cardiac rehabilitation (CR) in patients with HFrEF are well known, women seem to participate in CR significantly less compared to men. Purpose To determine whether there is a difference in the effects of CR on the tolerance of physical strain and the quality of life (QOL) related to gender in examinees with HFrEF. Methods The study involved 225 pts with HFrEF, 190 men (84.4%) and 35 women (15.56%), who were referred to a three-week CR program. At baseline and the end of CR exercise stress test (EST) was taken. The QOL was assessed at the beginning and the end of CR by validated questionnaire Short-Form 36. Results Male pts showed better strain tolerance on the first and the second EST compared to female pts. However, both gender showed improvement in physical strain tolerance on the second EST by achieving higher strain level (men 2.17±0.85 vs. 2.56±0.88, p=0.000; women 1.74±0.7 vs. 2.14±0.77, p=0.001), and longer duration of EST (men 2.56±2.97 vs. 5.64±2.85, p=0.000; women 2.28±2.46 vs. 4.63±2.4, p=0.000). Also, significantly more male and female pts achieved submaximal heart rate on the second EST (p=0.000 for men, and p=0.046 for women). Furthermore, CR has led to an improvement in the QOL in both men and women. Namely, all parameters were better at the end of CR, both in men and women. However, statistically significant improvements in female pts were noted in physical functioning (40±16.96 vs. 70±6.12, p=0.034), and energy/fatigue (43±17.54 vs. 62±20.49, p=0.041). On the other hand, the statistical significance in male pts was reached in physical functioning (59.38±25.57 vs. 67.23±23.47, p=0.002), energy/fatigue (60.43±22.7 vs. 64.08±21.22, p=0.036), emotional well-being (71.31±20.97, vs. 74.29±21.18, p=0.011), body pain (63.64±26.95 vs. 71.93±23.58, p=0.000), and general health (48.94±14.7 vs. 55.27±18.1, p=0.000). Conclusion Women generally less participate in CR than men. Results indicated that CR improves exercise capacity and QOL in HFrEF patients, in both men and women. This is why CR needs improvement in the referral and participation of women.