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November 19, 2002


Why Do Women Use Cardiac Rehab Less Than Men After Bypass Surgery? Emory Researcher Presents Explanation

CHICAGO - Coronary artery bypass grafting (CABG) relieves blockages in coronary arteries - but what happens after patients' bypass surgery is also important for promoting health and the best quality of life possible. One of the most important strategies to increase functional capacity and well-being in both men and women after CABG is participation in cardiac rehabilitation. Women, however, fail to participate in these rehab programs as often as men do.

The reasons for this difference have been unknown. But a new study, presented by Viola Vaccarino, M.D., Ph.D., of the Emory Department of Medicine's Division of Cardiology at the American Heart Association's Scientific Sessions, offers an explanation. "We found no evidence of a gender-related bias in referral to cardiac rehab in our results. Instead, we found that the single most important explanatory factor was the level of physical function after CABG. Women had lower function, and lower function was the strongest predictor of non-participation in both men and women," says Dr. Vaccarino, who headed the research team of Emory and Yale University investigators.

The scientists compared the use of cardiac rehabilitation programs between 578 men and 202 women who underwent CABG surgery between May, 1999, and February, 2001. Patients were interviewed at the time of surgery and six months after their CABG surgery. More of the women studied had a history of diabetes and hypertension, unstable angina and congestive heart failure than men at the time of bypass surgery - however, they were more likely to have fewer diseased vessels than their male counterparts. Although women were less likely to be referred to cardiac rehab after CABG than men, they were also less likely to participate in those programs (47% of women compared to 63% of men) even if they were referred.

"Sociodemographic differences (age, education, marital status, working status prior to CABG, and social support) explained very little about gender differences in rehab participation, despite the fact that women had more unfavorable levels of all these factors -- they were older, less educated, less often married, and had fewer sources of social support," says Dr. Vaccarino. "Lower physical function was a predictor of non-participation in cardiac rehab, even after adjusting for other health problems, disease severity and post-operative complications."

She points out that patients who have low levels of physical function, many of whom are women, are often the very patients who would benefit most from cardiac rehab programs. "Unfortunately, both men and women with physical limitations are the least likely to get rehab," says Dr. Vaccarino. "Health care providers should encourage low-functioning cardiac patients to participate in rehab programs. These patients may think that they are not up to it, but that's what rehab is for - it can help make them stronger, healthier and greatly increase the quality of life."

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