Women with coronary artery disease who completed a 12-week cardiac rehabilitation program were two-thirds less likely to die compared to those who were not referred to the program. In addition, the mortality benefit derived from this evidence-based program appears to be much more striking in women than men with the same condition, yet referrals and attendance among women fall short, according to research being presented at the American College of Cardiology's 62nd Annual Scientific Session.
"Cardiac rehabilitation can be a lifesaver, especially for women with coronary artery disease, but many aren't being referred, and even when they are, they are less likely to attend," said Jillian Colbert, MD, cardiology fellow in training at the University of Calgary, and the study's lead investigator, who said the results validate the results of earlier smaller studies. "With such a substantial mortality benefit, we are hoping these findings will prompt health care providers to refer women more and that more women will ask about these programs."
In this study, only one in three women was referred to cardiac rehab. Of those, only half actually attended. Compared to men, women had lower rates of referral (31.1 vs. 42.2 percent of men; p<0.0001) and attendance (50.1 vs. 60.4 percent; p<0.0001). They were also older (mean age 67.3 vs. 62.7), and had a higher prevalence of heart failure and diabetes.
Interestingly, women who are referred to a program but elect not to attend also seem to have better outcomes than those who were never referred. Dr. Colbert speculates that getting a referral in the first place may be associated with a referral bias in that these women are generally healthier than those not referred.
Cardiac rehab programs-long recommended by the American College of Cardiology and other groups-are now offered in most hospitals and medical centers in the U.S. and elsewhere. These structured 12-week programs are tailored to individual patients and are designed to help lower the risk of future heart problems. Cardiac rehab includes a mix of supervised exercise, nutrition counseling, stress management, smoking cessation assistance and education about the disease process, including how heart patients can take control of their own health and improve their outcomes.
So, why are so many women not going? There are many theories, but Dr. Colbert and her colleagues suspect it's because women juggle multiple family obligations and tend to put themselves, and their own health, last. Previous studies have also pointed to transportation issues, the need for insurance preapprovals and delays in scheduling the first appointment as common hurdles.
A total of 25,958 people were included in this study and were part of the database for the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, known as APPROACH. Of these, 6,374 or 24.6 percent were women. All had evidence of narrowing in one of the three arteries supplying the heart muscle with blood and oxygen. Researchers said this is the largest study to examine gender differences in the cardiac rehab referral rates and attendance patterns among adults with coronary artery disease, and they had access to up to 15 years of mortality data. Although this is not a multicenter study, baseline patient characteristics are similar to those typically seen in large U.S. studies, Dr. Colbert said.
"Cardiac rehabilitation is a proven method to decrease mortality in women with known coronary artery disease, and it works because it is multifaceted," she said. "It also helps women take an active role in their heart health and to better understand the steps they must take to reduce their personal risk and prevent problems."
More research is needed to better understand why cardiac rehab programs have such clear benefits in women, as well as measures to promote referral and attendance, which could benefit the one in three American women who will eventually develop coronary artery disease.
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