Referral to Cardiac Rehabilitation after ACS – Are Women Deprived?

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 the cardiology center in SZMC 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

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 was 38.6% in female and 41.2% in male; p=0.191. Program duration as well as number of meeting (median [IQR]) were similar in female and male (4.5[2.2-13.1] vs. 4.5[2.4-11.5] months; p=0.988 and 24[11-55] and 23[11-49] meetings; p=0.414 respectively

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. Improving referral rates of ACS patients, especially of women to CR according to guidelines will lower mortality and gender deprivation.