title: Cardiac rehabilitation referral, attendance and mortality in women.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) reduces mortality in women and men with coronary artery disease (CAD). The objective of this study was to examine sex differences in long-term mortality, based on CR referral rates and attendance patterns in a large CAD population.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) and Cardiac Wellness Institute of Calgary (CWIC) databases were used to obtain information on all patients. Rates of referral to and attendance at CR were compared by sex. Logistic regression models were constructed to assess whether sex predicted CR referral or completion. The association between referral, completion, and survival was assessed by sex using Cox proportional hazard models.
  
  
  RESULTS
  25,958 subjects (6374-24.6%-were women) with at least one vessel CAD were included. Females experienced reduced rates of CR referral (31.1% vs 42.2%, p < 0.0001) and completion (50.1 vs 60.4%, p < 0.0001). Adjusting for demographic and clinical characteristics, relative to men, CR referral was significantly lower in women (adjusted odds ratio (OR) 0.74, 95% CI 0.69, 0.79) as was CR completion (adjusted OR 0.73, 95% CI 0.66, 0.81). Women completing CR experienced the greatest reduction in mortality (HR 0.36, 95% CI 0.28, 0.45) with a relative benefit greater than men (HR 0.51, 95% CI 0.46, 0.56).
  
  
  CONCLUSIONS
  This is the first large cohort study to demonstrate that referral to and attendance at CR is associated with a significant mortality reduction in women, comparatively better than that in men.
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada.
authors.forename: Jillian D
authors.initials: JD
authors.lastname: Colbert
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada Cardiac Wellness Institute of Calgary (CWIC), Canada.
authors.forename: Billie-Jean
authors.initials: BJ
authors.lastname: Martin
authors.affiliation: Faculty of Rehabilitation Medicine, University of Alberta, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Haykowsky
authors.affiliation: Cardiac Wellness Institute of Calgary (CWIC), Canada.
authors.forename: Trina L
authors.initials: TL
authors.lastname: Hauer
authors.affiliation: TotalCardiology, Canada.
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Austford
authors.affiliation: Cardiac Wellness Institute of Calgary (CWIC), Canada Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Arena
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada.
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada Cardiac Wellness Institute of Calgary (CWIC), Canada TotalCardiology, Canada.
authors.forename: Donald An
authors.initials: DA
authors.lastname: Meldrum
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada Cardiac Wellness Institute of Calgary (CWIC), Canada TotalCardiology, Canada.
authors.forename: Sandeep G
authors.initials: SG
authors.lastname: Aggarwal
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Canada Cardiac Wellness Institute of Calgary (CWIC), Canada TotalCardiology, Canada stonej@ucalgary.ca.
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D015982:Bias; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery disease; cardiac rehabilitation; women