Paper
Friday, July 23, 2004
Women’s Utilization and Outcomes of Cardiac Rehabilitation
Colleen M. Norris, PhD, RN1, Louise Jensen, PhD, RN1, William Ghali, MD, MPH2, and P. Diane Galbraith, BN3. (1) Faculty of Nursing, University of Alberta, Edmonton, AB, Canada, (2) Faculty of Medicine, University of Calgary, Calgary, AB, Canada, (3) CHAPS, University of Calgary, Calgary, AB, Canada
| Learning Objective #1: Identify survival benefits for women referred to a cardiac rehabilitation program |
| Learning Objective #2: Identify health-related quality of life outcomes of women referred to a cardiac rehabilitation program |
Objective: The benefits of cardiac rehabilitation (CR) for patients with CAD are extensive and compelling demonstrating reductions in mortality. Studies report that only 10-20 % of eligible patients are referred to participate in CR programs. Furthermore 20% fewer women are enrolled in CR compared to men. The purpose of this study was to identify the proportion of women who were referred to CR in a large Canadian city, their statistically adjusted survival rates and their one and three-year health related quality of life (HRQOL) outcomes. Design: The prospective cohort design included all adult women with CAD, from 1995 to 1999, in the APPROACH registry. Sample: 1,180 women who survived greater than 6 months following catheterization were included in the analysis. Methods: Outcome variables included survival status and HRQOL. Bivariate analyses were performed using Chi-square and t-tests. Survival data were adjusted using a Cox proportional hazards model. HRQOL data were adjusted using general linear modeling. Findings: Crude hazard ratios indicated that referral to a CR program remained significant after controlling for clinical, anatomical, treatment and co-morbid conditions recorded at catheterization (HR=0.58 95% CI 0.34,1.00 p=0.05). Women who were referred to CR reported significantly higher scores (better HRQOL) in all 5 dimensions at both 1 and 3 year follow-up. Conclusions: Despite proven efficacy of CR in clinical trials, less than one third of women undergoing cardiac catheterization are referred to a CR program. Over and above the survival advantage, women who are referred to CR report better HRQOL outcomes at one and three-year follow-up relative to women who are not referred to CR. Implications: The better survival and HRQOL outcomes noted in women referred to CR suggests that there is an opportunity to improve care and outcomes through increased referral of women to CR programs.
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Sigma Theta Tau International
July 22-24, 2004