Secondary Prevention Recommendation Attainment with Cardiac Rehabilitation: Is there a Gender Disparity?

Background: Achievement of secondary prevention guideline recommendations (i.e., goals) with cardiac rehabilitation(CR)is not well documented, specifically for women. This study examined achievement of the American Heart Association/American College of Cardiology (AHA/ACC) goals pre-and post-CR by gender. METHODS: Of 12,976 patients enrolled in the Wisconsin CR Outcomes Registry,8,929 (68.8%) completed CR and were included in the sample. Attainment of 15AHA/ACC goals pre-and post-CR was examined, by extracting corresponding data points in the Registry, as entered by CR program staff. Gender differences in achievement of these goals post-CR were examined via generalized estimating equations technique. RESULTS: Attainment of AHA/ACC goals pre-CR ranged from15.3% of patients (physical activity) to 98.1% (aspirin),and by 17.6% (physical activity) to 98.4% (diastolic blood pressure) by CR completion. Significant improvements were achieved in 8(53.3%)goals, ranging from 0.7% for body mass indexto50.8%for physical activity. Women were significantly less likely than men to achieve the following goals by CR completion: triglycerides (adjusted odds ratio [AOR], 0.54; 95% confidence interval [CI]: 0.45-0.66), physical activity(AOR, 0.66; CI 0.59-0.74),and hemoglobin A1c(AOR, 0.50; CI 0.32-0.78).Women were significantly more likely than men to achieve the high-density lipoprotein goal (AOR, 1.39; CI 1.05-1.86). There were no significant gender differences in goal achievement for blood pressure, total cholesterol, low-density lipoprotein, body mass index, smoking cessation, or medication usage. More than 94% of 2patients were taking 3 of 4 recommended secondary prevention medications both pre-and post-program. CONCLUSIONS: Men and women generally improved similarly in terms of AHA/ACC goal achievement. Quality improvement strategies need to focus on physical activity and blood glucose control in women