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