Gender differences in risk factors and outcomes after cardiac rehabilitation

Sarrafzadegan, Nizal; Rabiei, Katayoun; Kabir, Ali; Sadeghi, Masoumeh; Khosravi, Alireza; Asgari, Seddighe; Taghipour, Hamid Reza; Roohafza, Hamidreza

doi:10.2143/ac.63.6.2033395

Cited by 15 publications

(22 citation statements)

References 26 publications

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“…Studies have shown that women are less likely to be referred to and enroll in CR 25 despite having more co-morbid conditions than men. 26 Our results further highlight the need for programs to target increased participation for women as they experience similar improvement in CR as men. 26 …”

Section: Discussionmentioning

confidence: 56%

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Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation

Khadanga

Savage²,

Ades³

2016

Journal of Cardiopulmonary Rehabilitation and Prevention

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PURPOSE The goal of this study was to determine the prevalence of Insulin Resistance (IR) and Type-2 Diabetes Mellitus (T2DM) in contemporary cardiac rehabilitation (CR) and to compare clinical responses in CR between these subsets of patients with coronary heart disease (CHD). METHODS The study cohort included 818 patients enrolled in CR. We separated the cohort into 3 groups: individuals with normal HbA1c (NoIR, glycated hemoglobin, HbA1c<5.7), individuals with insulin resistance (IR, HbA1c≥5.7<6.5), and individuals with T2DM (HbA1c≥6.5). RESULTS The combined prevalence of IR (44%) and T2DM (23%) was 67% which paralleled the prevalence of metabolic syndrome (MetSyn), present in 65% of patients. Women had a higher prevalence of IR and MetSyn than men (73% vs. 64%, 72% vs. 63%) and a greater percentage with an elevated waist circumference (71% vs. 60%) (all, p<0.05). All 3 groups experienced decreases in body weight (NoIR= −2.3±4.0, IR= −1.7±4.0, T2DM= −1.0±4.2kg) and increases in maximal METs at exercise testing (NoIR= +2.2±2.5 vs IR= +2.1±2.8 vs T2DM= +1.3±2.3) (all, p<0.05). Individuals with NoIR achieved greater improvements in weight, BMI, and METs compared to patients with T2DM (all, p<0.05). Selected individuals who participated in a 4-session behavioral weight loss program lost more than twice the weight as nonparticipants. CONCLUSIONS The combined prevalence of IR and T2DM in patients with CAD enrolled in CR was remarkably high (67%). To reverse the deleterious consequences of IR and T2DM, targeted interventions of exercise and weight loss need to be a central focus of CR programming.

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Section: Discussionmentioning

confidence: 56%

“…26 Our results further highlight the need for programs to target increased participation for women as they experience similar improvement in CR as men. 26 …”

Section: Discussionmentioning

confidence: 56%

Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation

Khadanga

Savage²,

Ades³

2016

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…Of the 103 middle-income countries globally, this search revealed CR services exist in 29 (28.2%) countries (Figure 1). These were: Algeria, 70 Argentina,42 Belarus, 69 Bosnia And Herzegovina, 69 Brazil, 68 Bulgaria, 69 China, 71 Colombia, 68 Costa Rica, 69 Cuba, 69 Ecuador, 42 Egypt, 72 India, 73 Indonesia, 74 Iran, 75 Malaysia, 69 Mexico, 68 Pakistan, 76 Panama, 69 Paraguay, 42 Peru, 68 Philippines, 43 Romania, 77 South Africa, 78 Sri Lanka, 69 Thailand, 69 Tunisia, 79 Turkey, 80 and Venzuela. 42 …”

Section: Cr Availability In Middle-income Countriesmentioning

confidence: 99%

“…In middle-income countries, women are similarly less represented than men (<30%) in CR. 73,75,100,101 Indeed in one CR study in Brazil, there were no women represented. 102 Given there is no evidence that these vulnerable groups derive less clinical benefit from CR, these disparities suggest that some vulnerable groups have even less access to CR than does the average patient.…”

Section: Disparities In Patient Access To Crmentioning

confidence: 99%

Global availability of cardiac rehabilitation

2014

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The most prevalent non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of the deaths occurring in low-and middleincome countries. To lessen the impact of CVDs on individuals and societies, a comprehensive approach is needed. Cardiac rehabilitation (CR) involves delivery of structured exercise, education and risk reduction, in a cost-effective manner. Robust evidence demonstrates it reduces mortality up to 25%, improves functional capacity, as well as decreases re-hospitalization. Despite its benefits, and clinical practice guideline recommendations to refer cardiac patients, CR programs are grossly under-used. Worldwide, there is low availability of CR; only 38.8% of countries globally have CR programs. Specifically, 68.0% of high-income and 23% of LMICs (28.2% for middle-and 8.3% for low-income countries) have CR. CR density estimates ranged from 1 program per 0.1-6.4 million inhabitants. CR availability is much lower than that of other evidencebased secondary prevention therapies, such as revascularization and pharmacological therapies. Multi-level strategies to augment CR capacity and availability at national and international levels such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed.

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“…It is well-established that CR results in significant reductions in CV mortality and morbidity, among other benefits also demonstrated in the EMR [6,7]. Despite this and its costeffectiveness [6,8,9], CR is not readily available in the region.…”

Section: Introductionmentioning

confidence: 99%

Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally?

Turk-Adawi

Supervía

Pesah

et al. 2019

International Journal of Cardiology

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Background: This study aimed to (1) confirm cardiac rehabilitation (CR) availability, (2) establish CR density and unmet need, as well as (3) the nature of programs in the Eastern Mediterranean Region (EMR), and (4) compare these (a) by EMR country and (b) to other countries. Methods: In this cross-sectional study, a survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. CR need was based on Global Burden of Disease study ischemic heart disease (IHD) estimates. Results: Of the 22 EMR countries, CR programs were identified in 12 (54.5%). Nine (75.0% country response rate) countries participated, and 24/49 (49.0% program response rate) surveys were initiated. There was 1 CR spot for every 104 incident IHD patients/year (versus 12 globally). One-third of responding programs were privately funded (n=8; versus globally p<.001), and in 18 (75.0%) programs patients paid some or all of the cost out-of-pocket (versus n=378, 36.3% globally; p<.001). Over 80% of programs accepted guideline-indicated patients. Nurses (n=20, 95.2%), cardiologists (n=18, 85.7%) and dietitians (n=18, 85.7%) were the most common healthcare providers on CR teams (mean=6.4±2.2/program; 5.9±2.8 globally, p=.18). On average, programs offered 8.9±1.7/11 core components (versus 8.7±1.9 globally, p=.90). These were most commonly initial assessment, management of risk factors, and patient education (n=21, 100.0% for each), and least commonly return-to-work counselling (n=15 71.4%). Mean dose was 27.0±13.5 sessions (versus 28.7±27.6 globally, p=.38). Seven (33.3%) programs offered some alternative models.

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Gender differences in risk factors and outcomes after cardiac rehabilitation

Abstract: Following a short-term cardiac rehabilitation programme, modification in cardiac risk factors and quality of life occurs. Both genders benefit alike in most aspects from this programme.

Cited by 15 publications

References 26 publications

Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation

Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation

Global availability of cardiac rehabilitation

Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally?

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