title: Secondary Prevention Recommendation Attainment with Cardiac Rehabilitation: Is There a Gender Disparity?
abstract: Achievement of secondary prevention guideline recommendations (i.e., goals) with cardiac rehabilitation (CR) is not well-documented, especially for women. This study examined achievement of the American Heart Association/American College of Cardiology (AHA/ACC) goals before and after CR by gender.
  
  
  
  Of 12,976 patients enrolled in the Wisconsin CR Outcomes Registry, 8,929 (68.8%) completed CR and were included in the sample. Attainment of 15 AHA/ACC goals before and after CR was examined by extracting corresponding data points in the registry as entered by CR program staff. Gender differences in achievement of these goals after CR were examined via generalized estimating equations technique.
  
  
  
  Attainment of AHA/ACC goals before CR ranged from 15.3% of patients (physical activity) to 98.1% (aspirin), and by 17.6% (physical activity) to 98.4% (diastolic blood pressure) by CR completion. Significant improvements were achieved for 8 goals (53.3%), ranging from 0.7% for body mass index (BMI) to 50.8% for physical activity. Women were significantly less likely than men to achieve the following goals by CR completion: triglycerides (adjusted odds ratio [AOR], 0.54; 95% confidence interval [CI], 0.45-0.66), physical activity (AOR, 0.66; 95% CI, 0.59-0.74), and hemoglobin A1C (AOR, 0.50; 95% CI, 0.32-0.78). Women were significantly more likely than men to achieve the high-density lipoprotein goal (AOR, 1.39; 95% CI, 1.05-1.86). There were no gender differences in goal achievement for blood pressure, total cholesterol, low-density lipoprotein, BMI, smoking cessation, or medication use. More than 94% of patients were taking three of four recommended secondary prevention medications both before and after the program.
  
  
  
  Men and women generally improved similarly in terms of AHA/ACC goal achievement. Quality improvement strategies need to focus on physical activity and blood glucose control in women.
authors.affiliation: School of Health Policy and Management, York University, Toronto, Ontario, Canada; The Heller School for Social Policy and Management, Brandeis University, Boston, Massachusetts. Electronic address: Karamturk2000@yahoo.com.
authors.forename: Karam I
authors.initials: KI
authors.lastname: Turk-Adawi
authors.affiliation: College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Oldridge
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Vitcenda
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sergey S
authors.initials: SS
authors.lastname: Tarima
authors.affiliation: Faculty of Health, York University, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D005783:Gender Identity; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D014922:Wisconsin