New research may help explain why women who suffer from heart disease are less likely than men to participate in potentially lifesaving cardiac rehabilitation programs.
Women hospitalized for a heart attack or unstable angina are far less likely than men to be referred to cardiac rehabilitation programs, even if they are good candidates, a new study in the April issue of General Hospital Psychiatry reveals.
The same study documents that even when women are referred, they complete the programs less frequently than men do. Lead investigator Sherry L. Grace, Ph.D., of the University Health Network Women’s Health Program in Toronto, cites evidence that this difference could stem from characteristics that are more common among the women: lower family income and less confidence that they can take action to improve their heart health.
Although cardiovascular disease is the leading cause of death and disability among both men and women, Grace notes, women have repeatedly been shown to be less likely to recover well. A woman who has a heart attack is more likely than a man to have a second attack or die within the first year.
At the same time, many studies document that women with heart disease are less likely than their male counterparts to participate in cardiac rehabilitation programs, which can decrease the risk of death by 25 percent.
Grace’s team followed 906 men and women from 12 coronary intensive care units in South-central Ontario. Each subject was observed during six months of normal care after admission for either a heart attack or unstable angina.
Each participant supplied basic demographic information, such as family income and age, and completed tests designed to measure such traits as anxiety levels and strength of social supports.
The results, Grace reports, duplicate previous observations of lower referral rates for women. Among eligible patients, 32 percent of men -- but only 21 percent of women -- are referred to cardiac rehabilitation by their physician or cardiologist.
Her team’s findings also indicate that among those referred for rehabilitation, the women are less likely to actually be participating six months after their hospital admission. Several traits believed to predict lower chances of participation, they found, are indeed more common among the women who receive referrals but are not involved at the six-month mark. Of these, lower family income and lower confidence that they can initiate and maintain a course of action that will improve their lives seem to be the greatest barriers.
These findings, according to Grace, indicate that “over and above referral failure, barriers to participation in cardiac rehab may also be psychosocial in nature.”
“Because virtually all studies demonstrate that women benefit from cardiac rehab, health professionals, family and friends need to be informed about sex differences in referral,” Grace advises. In addition, she says, “Coronary intensive care units and comprehensive cardiac rehab programs should include appropriate mental health professionals to identify and address … vital psychosocial aspects of recovery” such as those that predict a patient’s likelihood of participating in a cardiac rehabilitation program.
The research was supported by a UHN-Eli Lilly Women’s Health Fellowship and a grant from the Heart and Stroke Foundation.
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Don R. Lipsitt, M.D.,
at 617-661-3544.
Journal
General Hospital Psychiatry