Quality of life measures and gender comparisons in North Carolina Cardiac Rehabilitation Programs

Predictors of Health-Related Quality of Life Among Women Participating in an Appointment-Based Cardiac Rehabilitation Program

BACKGROUND

An alternative patient-centered appointment-based cardiac rehabilitation (CR) program has led to significant improvements in health outcomes for patients with cardiovascular disease. However, less is known about the effects of this approach on health-related quality of life (HRQoL), particularly for women.

OBJECTIVE

We examined the effects of a patient-centered appointment-based CR program on HRQoL by sex and examined predictors of HRQoL improvements specifically for women.

METHODS

Data were used from an urban single-center CR program at Yale New Haven Health (2012-2017). We collected information on patient demographics, socioeconomic status, and clinical characteristics. The Outcome Short-Form General Health Survey (SF-36) was used to measure HRQoL. We evaluated sex differences in SF-36 scores using t tests and used a multivariate linear regression model to examine predictors of improvements in HRQoL (total SF-36 score) for women.

RESULTS

A total of 1530 patients with cardiovascular disease (23.7% women, 4.8% Black; mean age, 64 ± 10.8 years) were enrolled in the CR program. Women were more likely to be older, Black, and separated, divorced, or widowed. Although women had lower total SF-36 scores on CR entry, there was no statistically significant difference in CR adherence or total SF-36 score improvements between sexes. Women who were employed and those with chronic obstructive pulmonary disease were more likely to have improvements in total SF-36 scores.

CONCLUSION

Both men and women participating in an appointment-based CR program achieved significant improvements in HRQoL. This approach could be a viable alternative to conventional CR to optimize secondary outcomes for patients.

Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation

Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. −2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.

Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes?

Ischaemic heart disease (IHD) has changed from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Most clinical studies during the past three decades have been conducted with men. Cardiac rehabilitation programmes were also developed with special regard to improving the rate of return to work in middle-aged men. The rehabilitation needs of older patients and women in particular have been largely neglected. The aim of this review is briefly to outline our present knowledge on gender issues in cardiac rehabilitation, and to specify barriers with regard to physical activities especially in (older) women. Coping with a cardiac event, women tend to minimize or play down the impact of their health situation and avoid burdening their social contacts. After a first cardiac event, women report greater psychological distress and lower self-efficacy and self-esteem. In addition, older age, lower exercise levels and reduced functional capacity or co-morbid conditions such as osteoporosis and urinary incontinence are barriers to physical activities in women with IHD. Recent studies on psychosocial intervention revealed less favourable results in women compared with men. These findings have not yet been well explained. This emphasizes our current lack of knowledge about the processes and determinants of successful psychosocial interventions in men and women with IHD. A large (European) trial on gender-specific coping styles, needs, and preferences of older women, and the effects of psychosocial intervention is proposed.

Clinical research in cardiac rehabilitation and secondary prevention: looking back and moving forward

Cardiac rehabilitation/secondary prevention (CR/SP) programs are considered standard of care and provide critically important resources for optimizing the care of cardiac patients. The objective of this article is to briefly review the evolution of CR/SP programs from a singular exercise intervention to its current, more comprehensive multifaceted approach. In addition, we offer perspective on critical concerns and suggest future research considerations to optimize the effectiveness and utilization of CR/SP program interventions.

The Coronary Health Improvement Project (CHIP) for Lowering Weight and Improving Psychosocial Health

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF–36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.

The Montana cardiac rehabilitation regional outcomes project

PURPOSE

Outcomes evaluation is a critical component in early outpatient cardiac rehabilitation (CR). The goal of this project was to develop a regional CR outcomes program to help facilitate quality improvement.

METHODS

The Montana Outcomes Project initiated data collection on a uniform set of outcomes indicators. Each participating program submitted de-identified data for analysis on a quarterly basis. Results were sent back to each program with its individual program data plotted against the regional mean.

RESULTS

Year 1 data collection included outcomes information from 22 facilities and 850 patients. Mean age was 68 years, 96% were white, 68% were men, and the mean number of CR visits was 24. The mean resting blood pressure at program completion was 118/68 mm Hg, with 90% of patients meeting criteria for blood pressure control (<140/90 or <130/80 mm Hg for patients at high risk). Mean low-density lipoprotein was 87 mg/dL; 94% were on lipid-lowering medications; and 73% achieved low-density lipoprotein values of less than 100 mg/dL. Upon program completion, significant improvements (P < .001) were noted in prescore versus postscore for functional capacity measured by the Duke Activity Status Index (5.5 metabolic equivalents vs 7.3 metabolic equivalents), Medical Outcomes Study SF-36 Health Status Questionnaire physical (36.9 vs 45.8) and mental (47.2 vs 52.2) composite scores, Dartmouth Primary Care Cooperative questionnaire (22 vs 15.9), and fat intake measured by the Block Dietary Fat Screener (19.6 vs 14.7).

CONCLUSION

Our findings suggest that the development of a regional CR outcomes project is feasible and could aid in the development of quality improvement projects.

Are there meaningful longitudinal changes in health related quality of life--SF36, in cardiac rehabilitation patients?

BACKGROUND

This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data.

METHODS

In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme.

RESULTS

There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase.

CONCLUSIONS

These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.

Association of Age and Quality of Life Following Phase II Cardiac Rehabilitation

The benefits of cardiac rehabilitation following a major cardiac event are without question. Less well known, however, is the association of age with improved quality of life following rehabilitation. Subjects (n = 300) completed a 3-month phase II cardiac rehabilitation program following either a coronary artery bypass graft or a valve procedure. There were similar gains in health-related quality of life across all age groups; our results suggest that there needs to be a greater focus on emotional needs among our younger patients.

Effect of Functional Health-Related Quality of Life on Long-Term Survival After Cardiac Surgery

Background— Health-related quality-of-life instruments have become important measures of early health outcomes after cardiac surgery. The relationship between quality of life after recovery from surgery and subsequent long-term survival has not previously been explored. Our objective was to determine whether the Duke Activity Status Index (DASI) was predictive of subsequent time-related survival after recovery from cardiac surgery.

Methods and Results— We examined survival status among 6305 patients who underwent isolated coronary artery bypass grafting with or without valve procedures or isolated valve procedure between May 1995 and June 1998 who had a preoperative baseline and follow-up DASI. The postoperative DASI was administered nominally at 6 and 12 months. Baseline and perioperative variables and postoperative morbid events were prospectively collected concurrently with patient care. The end point was all-cause mortality. The Social Security Death Index was queried for survival status. Cox proportional-hazards analysis was used to study the associations between DASI, a number of traditional risk factors, and survival. Median follow-up was 8.6 years. The “dose-response” relationship between baseline and follow-up DASI and risk of long-term death was established. Follow-up DASI was associated with risk-adjusted long-term survival hazard ratio of 0.98 per unit increase (confidence limits, 0.97 to 0.98; P <0.0001). Achieving maximum baseline DASI was associated with better risk-adjusted long-term survival (hazard ratio, 0.64; confidence limits, 0.50 to 0.83; P =0.0005).

Conclusions— Poor health-related quality of life after recovery from cardiac surgery identifies patients who are at risk for reduced long-term survival.

Effect of intense lifestyle modification and cardiac rehabilitation on psychosocial cardiovascular disease risk factors and quality of life

This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation (CR) on psychosocial risk factors and quality of life in patients with confirmed coronary artery disease. Participants had previously undergone a revascularization procedure. The 84 patients self-selected to participate in the Ornish Program for Reversing Heart Disease (n = 507 28), CR (n = 28), or a control group (n = 28). Twelve psychosocial risk factors and quality of life variables were collected from all three groups at baseline, 3 months, and 6 months. At 3 and 6 months, Ornish group participants demonstrated significant improvements in all 12 outcome measures. The rehabilitation group improved in 7 of the 12, and the control group showed significant improvements in 6 of the variables. Intensive lifestyle modification programs significantly affect psychosocial risk factors and quality of life.

Fatigue et maladies cardiovasculaires

Fatigue is a frequent complaint during cardiovascular disease and can sometimes constitute the first clinical manifestation of this disease. It is responsible for deterioration of the quality of life and prognosis. Although physical and mental fatigue are often intimately interrelated, these two aspects of fatigue correspond to different pathophysiological mechanisms and different clinical features and the neurobiological links between the two are only just beginning to be studied. Physical fatigue is related to loss of efficacy of the effector muscle, due to multiple causes: mismatch of cardiac output during exercise, muscle and microcirculatory deconditioning, neuroendocrine dysfunction, associated metabolic disorders. Mental fatigue corresponds to predominantly depressive mood disorders with a particular entity, vital exhaustion. The diagnostic approach is designed to eliminate other organic causes of fatigue. Functional tests investigating physical (exercise capacity) and mental dimensions (mood disorders) can be used to analyse their respective roles and to propose personalized management, in which rehabilitation has an essential place due to its global approach. The objective of this reduction of fatigue is threefold: to improve independence, to improve quality of life and to limit morbidity and mortality.

Validity and Reliability of the North Carolina 6-Minute Cycle Test

PURPOSE

The purposes of this investigation were to determine (1) if the 6-minute cycle (6MC) test is a valid and reliable measure of physical performance in cardiac patients and (2) if physiologic responses to the 6-minute walk (6MW) and 6MC tests differ in men and women.

METHODS

Subjects were 101 phase II cardiac rehabilitation patients aged 40 to 79 years. Each subject performed a maximal graded exercise test (MGXT), a 6MW test, and three 6MC tests on separate days.

RESULTS

Pearson product moment correlation r values ranged from 0.78 to 0.89 (P = .001) when the three 6MC tests were compared with one another, indicating good test/retest reliability. The 6MC tests were all significantly and positively correlated to 6MW distance (P < .01), with r values ranging from 0.55 to 0.59. Each 6MC test was also correlated with maximal graded exercise test total time (P < .01), with r values ranging from 0.51 to 0.63, and with estimated maximal metabolic equivalents (P < .01), with r values ranging from 0.44 to 0.60. Although heart rate, systolic blood pressure, rate-pressure product, and rating of perceived exertion values for men were greater during the 6MC test than during the 6MW test (P < .001), no differences were seen in these parameters between tests in women (P = .166 to.260), with the exception of a greater exercise rating of perceived exertion seen during the 6MC test(P = .009).

CONCLUSION

The North Carolina 6MC test seems to provide a valid and reliable measure of functional abilities in phase II cardiac rehabilitation participants. Men generally present with greater heart rate, systolic blood pressure, and rate-pressure product values during this test than do the women when compared with a standard 6MW test.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

Quality-of-life changes following the completion of phase II cardiac rehabilitation

In this study, 302 patients who were completing Phase II cardiac rehabilitation were assessed at their entrance to cardiac rehabilitation and at 3 months. After 3 months, subjects improved on 8 of 9 dimensions. Greatest gains were in Fitness (22.5%, P < .0001) and Daily Activities (24.4%, P < .0001). Despite stratification by gender, a sedentary lifestyle, and tobacco use, quality of life was markedly improved at the completion of rehabilitation. Completion of a Phase II cardiac rehabilitation program can lead to statistically significant increases in the quality of life following consequential cardiac events.

Perceived coping, social support, and quality of life 1 month after myocardial infarction: a comparison between Swedish women and men

OBJECTIVE

The study objective was to compare coping, social support, and quality of life in Swedish women and men 1 month after myocardial infarction.

DESIGN

The study design was cross-sectional and descriptive-comparative.

SETTING

The study took place in 1 hospital service area in the middle of Sweden.

SUBJECTS

The sample consisted of 74 women and 97 men.

INSTRUMENTS

The Jalowiec Coping Scale, the Social Network and Social Support Questionnaire, the Short Form-36 Health Survey, and the Quality of Life Index-Cardiac Version were used.

RESULTS

Compared with men, women used more evasive and supportive coping and rated psychologic aspects of the heart disease as more problematic to manage. More women perceived available support from friends and grandchildren, and more men perceived available support from their partner. Women rated lower levels in physical and psychologic dimensions of quality of life.

CONCLUSION

The first month after myocardial infarction is a susceptible period especially for women. They used more evasive and supportive coping and experienced a lower quality of life compared with men.

Specific profile and referral bias of rehabilitated patients after an acute coronary syndrome

PURPOSE

Cardiac rehabilitation after acute coronary syndrome is an important but underused therapeutic intervention. The aim of the French nationwide PREVENIR survey was to improve knowledge on the management of cardiovascular risk factors, especially during cardiac rehabilitation after acute coronary syndrome. The purpose of this study was to specify the characteristics of patients referred to cardiac rehabilitation.

METHODS

The survey was performed in 77 of 501 (15.4%) public or private French coronary care units. All French regions were involved. All the patients admitted to the hospital during January 1998 who survived an acute coronary syndrome were included in the survey. Data on rehabilitation practice were collected from patient medical records, either during an outpatient consultation or from the patient and the general practitioner during the 6-month follow-up period.

RESULTS

Of the 1394 patients included in the study (779 with myocardial infarction and 615 with unstable angina), only 310 (22%) underwent cardiac rehabilitation. Significant differences in patient characteristics were found between the cardiac rehabilitation and non-cardiac rehabilitation groups, respectively, in terms of gender (82% male vs 68%; P <.001), age younger than 65 years (56% vs 39%; P <.001), type of acute coronary syndrome (75% myocardial infarction vs 50%; P <.001), left ventricular ejection fraction less than 35% (6% vs 13%; P <.0004), and prevalence of percutaneous intervention (54% vs 46%; P <.02). Two risk factors were more common in the rehabilitated group: dyslipidemia (52% vs 44%; P <.02) and current smoking (51% vs 37%; P <.0001). In the multivariate analysis, female gender (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.44-0.87) and older age (>75 years vs. <65 years; OR, 0.40; 95% CI, 0.3-0.7) predicted decreased cardiac rehabilitation prescription. Conversely, previous history of dyslipidemia (OR,1.4; 95% CI, 1.04-1.8), post-myocardial infarction (OR, 2.8; 95% CI, 2.13-3.89), and a percutaneous intervention (OR,1.9; 95% CI, 1.3-2.7) predicted increased cardiac rehabilitation prescription. Severe left ventricular impairment (< or =35% vs >50%) was not an independent factor for cardiac rehabilitation prescription. At 6-month follow-up assessment, rehabilitation patients had a lower rate of hypertension (18% vs 27%), elevated low-density lipoprotein cholesterol (54% vs 62%), and continued smoking (34% vs 50%).

CONCLUSIONS

The results of the PREVENIR survey underscore the low level of cardiac rehabilitation prescription in France, and the relative exclusion of women and elderly people. Among the risk factors, dyslipidemia and current smoking are more frequent among rehabilitated patients. These findings may help to modify the strategy for using cardiac rehabilitation after acute coronary syndrome, although it is an effective intervention for secondary prevention.

Social support as a predictor of participation in cardiac rehabilitation after coronary artery bypass graft surgery

PURPOSE

Cardiac rehabilitation promotes recovery and enhances quality of life after a coronary artery bypass graft (CABG), but participation in such rehabilitation is low. The role of social support in promoting participation has been suggested by prior studies, but is not clearly defined. The purpose of this study was to investigate the role of social support as an independent predictor of participation in cardiac rehabilitation.

METHODS

This study examined 944 patients who underwent first isolated CABG between May 1999 and February 2001, then were followed for 6 months after surgery. Social support before CABG and 6 weeks after CABG was assessed using the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory (ESSI) and evaluated for its association with participation in cardiac rehabilitation.

RESULTS

Of 944 patients, 524 (56%) reported participation in rehabilitation. The participants were younger, better educated, more often employed, and less financially strained. The participants also had a lower prevalence of cardiovascular disease risk factors and better physical function. According to unadjusted analysis, the patients with low social support (ESSI </= 22) before surgery were less likely to participate in rehabilitation than the other patients (52% vs 59%; risk ratio [RR], 0.89; 95% confidence interval [CI], 0.78-0.99). However, adjustment for demographic factors, medical history, cardiovascular disease risk factors, physical and psychological function, and hospital complications attenuated this association (adjusted RR, 0.92; 95% CI, 0.78-1.07). A low ESSI score measured 6 weeks after CABG similarly did not significantly affect participation in rehabilitation (adjusted RR, 0.96; 95% CI, 0.81-1.11).

CONCLUSIONS

Contrary to what is believed generally, social support may not be a strong determinant of participation in rehabilitation after CABG. Correlates of social support such as gender, socioeconomic status, and comorbidity burden may have a more important role in cardiac rehabilitation participation than social support itself. When marital status was examined as a main predictive variable, the analyses yielded similar results (unadjusted RR, 0.72; 95% CI, 0.58-0.86; RR adjusted for the same covariates, 0.80; 95% CI, 0.60-1.02).

Outcomes Evaluation in Cardiac Rehabilitation/Secondary Prevention Programs

The reported outcomes statement is an update to the previous recommendations for outcomes evaluation in cardiac rehabilitation/secondary prevention programs. The purposes of outcomes evaluation are reviewed, and practical information with examples is provided to help programs implement an outcomes-directed approach within routine patient care and program management functions.

The Influence of an Intense Cardiovascular Disease Risk Factor Modification Program

In an effort to make intensive lifestyle modification programs more accessible to patients with cardiovascular disease, the Ornish Program was offered at eight independent medical centers located across the United States. The purpose of this study was to determine if one of these independent sites was able to replicate outcomes produced by the original Ornish Program. Fifty program participants from six different cohorts provided baseline, 3- and 12-month data consisting of blood lipids, body fat, blood pressure, anginal pain, quality of life, stress, depression, social support, and hostility. A pooled analysis showed significant reductions in almost all physiological and psychosocial variables with most reductions persisting for at least 12 months. These findings suggest that cardiovascular disease patients who choose to participate in an independent, intensive lifestyle modification program can experience significant improvements in both physiological and psychosocial cardiovascular disease risk factors.

Outcomes of cardiac rehabilitation participants and nonparticipants in a rural area

Nationally, only 11%-20% of cardiac patients, on average, enroll in cardiac rehabilitation programs after their cardiac events. The purpose of this study was to examine: (a) differences in functional health outcomes, clinical risk factor outcomes, and lifestyle behaviors between patients who participated in cardiac rehabilitation (CR) and those who did not during the first year after their cardiac event; and (b) to examine predictors of and reasons for CR participation and non-participation in a Midwestern, rural clinical population. Green's health education framework guided the study. A cross-sectional, comparative design was used to mail surveys to 538 cardiac patients who were hospitalized over a 1-year period at a regional medical center; 255 surveys were returned, and the final sample numbered 222. Of these, 154 (69%) attended CR. Compared to nonparticipants (n = 68), participants reported significantly higher levels of functioning on 7 of the 8 subscales of the Medical Outcome Study Short Form-36 (SF-36). In relation to clinical risk factor outcomes, participants had a significantly lower body mass index than nonparticipants. Patients who attended CR reported that they had switched to low-fat foods, started an exercise program, lost weight, lowered stress, lowered blood pressure, and reduced blood cholesterol at significantly higher rates than non-participants. Patients were more likely to participate in CR if their physician explained its benefits, if they were told about it during their hospitalization, and if they lived close to a CR program. Patients with coronary heart disease need to be referred to CR for improved physical and psychosocial functioning and successful risk factor modification.

Cardiac rehabilitation secondary prevention programs

Contemporary cardiac rehabilitation programs are more accurately described as "secondary prevention centers." They offer comprehensive care for the patient with cardiovascular disease, resulting in decreased mortality, improvement of most cardiac risk factors, and an enhanced quality of life. Although overall participation has increased with enhanced recognition of the importance of secondary prevention, 80% of eligible patients still do not participate, in part due to lack of insurance reimbursement. This rate can be significantly increased by specific endorsement from the physician.

Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion

OBJECTIVES

The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence women's referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future women's health research.

METHODS

Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-review literature.

RESULTS

The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention.

CONCLUSIONS

Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect women's participation.