Women and cardiac rehabilition in Mallorca
Authors: Moranta Ribas ME , Torres Marques J , Melia Mesquida C , Serra Creus J , Magnani Raganato S , Ruiz Pizarro V , Alvarez Rubio J , Cremer Luengos D , Ripoll Vera T , Gamez Martinez JM , Ferrer Oliver JA , Jardi Rodriguez AM , Trias Oliver C , Gomez Monjo MJ , Bestard Socias C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Women are less likely to be referred to a cardiac rehabilitation program (CRP) than men. Little is known about the different indications between genders and whether women who attend a CRP have different health characteristics from men.

Purpose
To study the differences between men and women in the frequency of referral to the only CRP in Mallorca (Spain), their indication and whether there were different health characteristics by gender among referred patients.

Methods
Retrospective observational study. We studied the indication, cardiovascular risk factors (CVRF), somatometric data, blood test and psychosocial health (by hospital anxiety and depression scale, HADS) of all patients referred to a CRP in Mallorca since the program was launched in 2014.

Results
524 patients have been referred to the CRP. 18% (95) were women, with no differences in mean age compared to men (55.9 ± 11 vs 56.2 ± 10 years).
Women were referred more frequently due to non-coronary diseases (20% vs 4%, p &lt;0.05), such as congenital heart disease, valve disease, or heart failure due to other cardiomyopathies.
Among patients referred with coronary disease (485), only 15.7% (76) were women. The most frequent indication (84% in men and 80% in women) was an acute coronary syndrome (ACS), with similar percentages of NSTEACS and STEACS (women 43 and 57%, men 41 and 59%). Women were referred more frequently due to chronic coronary syndrome than men (17% vs 5%, p &lt;0.05) and only one woman was referred after a coronary artery bypass grafting (vs 19 men, 1% vs 4%).
Among patients with coronary disease, women had less frequent history of smoking (64% vs 81%, p &lt;0.05), but similar percentages of other classic CVRF (Hypertension -59 vs 56% -, diabetes -27% vs 26% - and dyslipidemia -59% vs 63% - p&gt;0,05).
Women didn’t have significant differences when compared to men in their levels of LDL cholesterol (73 ± 23 vs 76 ± 25), triglycerides (122 ± 64 vs 135 ± 72), HbA1c (6.2 ± 1% vs 6, 1 ± 3%), p&gt;0,05. A lower percentage of women were overweight or obese (71% vs 85%, p &lt;0.05).
Women with ischemic heart disease referred to the CRP had a higher degree of anxiety and depression measured in the HADS questionnaire (anxiety 9.2 ± 4 vs 7.0 ± 4, depression 6.7 ± 5 vs 5.1 ± 4, p &lt;0.05). The percentage of women with a high degree of anxiety or depression (score&gt; 11 in HADS) was higher than for men (anxiety 44% vs 22%, depression 24% vs 13%, p &lt;0.05).

Conclusions
Only 18% of the patients referred to a CRP in Mallorca were women. This percentage was lower (15,8%) in patients with coronary disease referred to CRP. Women were referred in a higher percentage of cases than men for non-coronary pathology and chronic coronary syndrome. A lower percentage of women with coronary disease were smokers, overweighted or obese. Finally, a higher degree of anxiety and depression was observed among women than among men.