RESEARCH REPORT PLATFORM PRESENTATION

CLINICAL EFFECTIVENESS OF A CARDIAC REHABILITATION AND PRIMARY PREVENTION PROGRAM DESIGNED FOR WOMEN. Price J, Landry M, Delos-Reyes F, Rolfe D, Childerhose D, Sternberg L; Women’s Cardiovascular Health Initiative, Women’s College Hospital, Toronto, Ontario, Canada

PURPOSE: Background: Cardiac Rehabilitation (CR) has been shown to be an important intervention in the care of cardiovascular patients, however studies have reported lower enrollment and participation rates for women compared to men. In addition to this under-representation in traditional CR programs, there is a large dropout rate among women. The purpose of this paper is to present outcomes from this gender-specific program. RELEVANCE: The Women’s Cardiovascular Health Initiative is unique in Canada and offers comprehensive CR and primary prevention (PP) programs for women. Components of the program include exercise training, group education sessions on risk factor and lifestyle modification strategies, and individual counseling and support. All of these components encourage individual lifestyle changes, while also considering the context of each woman’s life by utilizing a women-centered model to guide its content and delivery. This may improve outcomes for women who may otherwise not access or drop out of such programs. PARTICIPANTS: Of 768 clients assessed for entry, 697 women enrolled between 11/01/1996 to 12/31/2003, with 298 joining the CR stream and 308 in PP. Baseline characteristics were described and compared between CR and PP clients. METHODS: This study is a retrospective cohort study design. Data was collected through WCHI database files, individual client charts, and the self-administered survey questionnaire. ANALYSIS: Among 590 completers, clinical outcomes (exercise capacity, body mass index (BMI), waist circumference, body fat percentage) and health outcomes (SF-36 physical and mental summary scores) were compared before and after the program using a t-test. RESULTS: Of the 632 women enrolled between November 1, 1996 and May 31, 2004, 315 patients entered CR (mean age = 64.4±11.4 yrs) and 317 entered PP (mean age = 57.6±10.1 yrs). Baseline characteristics will be described in both CR and PP patients. Among 542 patients completing the program, clinical outcomes (exercise capacity, body mass index (BMI), waist circumference (WC), body fat percentage (BF)) and health outcomes (SF-36 physical and mental summary scores) were assessed before and after partaking in the program. The compliance rate to completion for both groups was 85%. Statistically significant improvements (p < 0.0005) in exercise capacity (mean change = 2.36 METS ±1.77 (CR) (n=218), 1.86±1.58 METS (PP) (n=213)), BMI (mean change −0.53±1.35 (CR), −0.82±3.16 (PP)), WC (mean change −2.7±4.61 cm (CR), −1.88±4.05cm (PP)), BF (−0.56±2.32% (CR), −1.11±1.75% (PP)) and SF-36 physical scores (4.3±7.94 (CR), 2.93±7.55 (PP)), mental scores (3.02±9.31 (CR), 3.64±8.67 (PP)) were observed at time of discharge. CONCLUSIONS: The valuable effects of participation in a women-centered program, demonstrated by improvements in exercise capacity, quality of life, and greater patient compliance, provides evidence of the need for consideration of gender-specific variables when designing and implementing CR and PP programs for women. IMPLICATIONS: The implications for clinical practice and health care policy are far reaching. One should consider gender specific variables in the design of Cr and PP programs to improve outcomes for women. KEYWORDS: Cardiac rehabilitation, women’s health, outcomes. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: mireille.landry@wchospital.ca

ETHICS COMMITTEE: Ethics approval from the Toronto Academic Health Sciences Council Ethics Review Board, for Research Ethics Involving Human Subjects was awarded