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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Sex Differences in Cardiac Rehabilitation Outcomes
Joshua R Smith1, Randal J Thomas1, Amanda R Bonikowske1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Insights
Cardiac rehabilitation (CR) improves outcomes but has significant sex disparities. Addressing barriers in referral, enrollment, and completion is crucial for equitable cardiovascular disease secondary prevention.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a major global health burden.
- Cardiac rehabilitation (CR) is a vital secondary prevention strategy recommended by major cardiology organizations.
- CR participation improves patient outcomes, including risk factor management, quality of life, exercise capacity, and reduces mortality.
Purpose of the Study:
- To review existing sex disparities in outpatient phase II cardiac rehabilitation (CR).
- To examine differences in CR referral, enrollment, and completion rates between sexes.
- To identify patient, provider, and socio-environmental barriers impacting female CR participation.
Main Methods:
- Systematic review of literature on sex differences in CR care.
- Analysis of CR participation rates (referral, enrollment, completion) by sex.
- Evaluation of sex-based differences in core CR components (assessment, exercise, hypertension management).
- Review of strategies to mitigate sex disparities in CR.
Main Results:
- Significant sex disparities exist across the CR care spectrum, from referral to completion.
- Barriers to CR participation disproportionately affect females.
- Differences are noted in patient assessment, exercise training, and hypertension management within CR programs.
Conclusions:
- Addressing sex disparities in CR is essential for equitable cardiovascular disease secondary prevention.
- Strategies like automatic referral, gender-specific programs, and hybrid models show promise.
- Further research is needed to minimize and prevent sex differences in CR programming.
Abstract:
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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