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Najafi M, Teimouri-Jervekani Z, Jamalian M, Roohafza H, Paknahad MH, Hadavi MM, Dorostkar N, Sadeghi M. Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran. Egypt Heart J 2024; 76:133. [PMID: 39365397 PMCID: PMC11452575 DOI: 10.1186/s43044-024-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. METHODS A cohort study was performed on those who were candidates for CR programs during 2001-2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. RESULT In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both < 0.001) in the adjusted model, the emotional variables and Mets changes were significant in two groups, so that the emotional score in the female group was higher than that of the male group, and the female Mets score was significantly lower than that of the male group. CONCLUSION The CR program can improve cardiovascular outcomes, but the greatest impact was on the quality of life, patient METs and smoking behavers. Also the number of female participants in the CR program was less than the number of males.
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Affiliation(s)
- Marzieh Najafi
- Department of Cardiology, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Teimouri-Jervekani
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Marjan Jamalian
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Paknahad
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mahdi Hadavi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Dorostkar
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Redfern J, Gallagher R, Maiorana A, Candelaria D, Hollings M, Gauci S, O'Neil A, Chaseling GK, Zhang L, Thomas EE, Ghisi GLM, Gibson I, Hyun K, Beatty A, Briffa T, Taylor RS, Arena R, Jennings C, Wood D, Grace SL. Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation. NPJ CARDIOVASCULAR HEALTH 2024; 1:22. [PMID: 39359645 PMCID: PMC11442299 DOI: 10.1038/s44325-024-00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/25/2024] [Indexed: 10/04/2024]
Abstract
During the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management. The physical and emotional effects of living with CVD are ongoing with broad challenges ranging from the individual to system level. However, post-discharge care of people with coronary disease continues to follow a 50-year-old cardiac rehabilitation model which focuses on the sub-acute phase and is of a finite in duration. The aim of this paper is to consider the concept of supporting survivors to live well with CVD rather than 'rehabilitating' them and propose factors for consideration in reframing secondary prevention towards optimizing cardiovascular health. We discuss deeply-held potential considerations and challenges associated with the concept of supporting survivors achieve optimal cardiovascular health and live well with CVD rather than 'rehabilitating' them. We propose the concept of 5 x P's for reframing traditional cardiac rehabilitation towards the concept of cardiovascular health for survivors beyond 'rehabilitation'. These include the need for personalization, processes, patient-centered care, parlance, and partnership. Taken together, consideration of challenges at the systems and population level will ultimately improve engagement with secondary prevention as well as outcomes for all people who need it.
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Affiliation(s)
- Julie Redfern
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, NSW Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Andrew Maiorana
- Curtin School of Allied Health, Curtin University, Bentley, WA Australia
- Allied Health Department, Fiona Stanley Hospital, Murdoch, WA Australia
| | - Dion Candelaria
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Matthew Hollings
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Sarah Gauci
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC Australia
| | - Georgia K Chaseling
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD Australia
| | | | - Irene Gibson
- School of Medicine, University of Galway, Galway, Republic of Ireland
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
- Cardiology Department, Concord Hospital, ANZAC Research Institute, Concord, NSW Australia
| | - Alexis Beatty
- Alexis L Beatty, Departments of Epidemiology & Biostatistics and Medicine, University of California, California, USA
| | - Tom Briffa
- University of Western Australia, Crawley, WA Australia
| | - Rod S Taylor
- School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland UK
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL USA
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health NIPC and University of Galway, Galway, Republic of Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health NIPC and University of Galway, Galway, Republic of Ireland
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON Canada
- KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON Canada
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Marzolini S. Clinician's Commentary on Moncion et al. 3. Physiother Can 2024; 76:134-136. [PMID: 38465316 PMCID: PMC10919357 DOI: 10.3138/ptc-2021-0118-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, ON, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, ON, Canada;
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Cardiovascular and Pulmonary Research: The Year (2021) in Review. Cardiopulm Phys Ther J 2022. [DOI: 10.1097/cpt.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mamataz T, Ghisi GL, Pakosh M, Grace SL. Outcomes and cost of women-focused cardiac rehabilitation: A systematic review and meta-analysis. Maturitas 2022; 160:32-60. [PMID: 35550706 DOI: 10.1016/j.maturitas.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this systematic review was to investigate the effects of women-focused cardiac rehabilitation (CR) on patient outcomes and cost. METHODS Medline, PubMed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception through to May 2020. Primary studies of any design were included, with adult females with any cardiac diseases. "Women-focused" CR comprised programs or sessions with >50% females, or 1-1 programming tailored to women's preferences. No studies were excluded on the basis of outcome. Two independent reviewers rated citations for potential inclusion, and one extracted data, including on quality, which was checked independently. Random-effects meta-analysis was used where there were ≥3 trials with the same outcome; certainty of evidence for these was determined based on GRADE. For other outcomes, SWiM was applied. RESULTS 3498 unique citations were identified, of which 28 studies (52 papers) were included (3,697 participants; 11 trials). No meta-analysis could be performed for outcomes with "usual care" comparisons. Compared to "active comparison" group, women-focused CR had no meaningful additional effect on functional capacity. Women-focused CR meaningfully improved physical (mean difference [MD]=6.37, 95% confidence interval [CI]=3.14-9.59; I2=0%; moderate-quality evidence) and mental (MD=4.66, 95% CI=0.21-9.11; I2=36%; low-quality evidence) quality of life, as well as scores on seven of the eight SF-36 domains. Qualitatively, results showed women-focused CR was associated with lower morbidity, risk factors, and greater psychosocial well-being. No effect was observed for mortality. One study reported a favorable economic impact and another reported reduced sick days. CONCLUSIONS Women-focused CR is associated with clinical benefit, although there is mixed evidence and more research is needed. PROSPERO REGISTRATION CRD42020189760.
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Affiliation(s)
| | - Gabriela Lm Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review. BMC Cardiovasc Disord 2021; 21:459. [PMID: 34556036 PMCID: PMC8458788 DOI: 10.1186/s12872-021-02267-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception to May 2020. Primary studies of any design were included. Adult females with any cardiac diseases, participating in women-focused CR (i.e., program or sessions included ≥ 50% females, or was 1-1 and tailored to women’s needs) were considered. Two authors rated citations for inclusion. One extracted data, including study quality rated as per the Mixed-Methods Assessment Tool (MMAT), which was checked independently by a second author. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results 3498 unique citations were identified, with 28 studies (53 papers) included (3697 women; ≥ 10 countries). Globally, women-focused CR is offered by 40.9% of countries that have CR, with 32.1% of programs in those countries offering it. Thirteen (46.4%) studies offered women-focused sessions (vs. full program), 17 (60.7%) were women-only, and 11 (39.3%) had gender-tailoring. Five (17.9%) programs offered alternate forms of exercise, and 17 (60.7%) focused on psychosocial aspects. With regard to utilization, women-focused CR cannot be offered as frequently, so could be less accessible. Adherence may be greater with gender-tailored CR, and completion effects are not known. Satisfaction was assessed in 1 trial, and results were equivocal. Conclusions Women-focused CR involves tailoring of content, mode and/or sex composition. Availability is limited. Effects on utilization require further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02267-0.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gabriela L M Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,Peter Munk Cardiac Centre, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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