Classification(s): Cardiac Rehabilitation; Primary Prevention/Epidemiology
Introduction: The 2006 update to the AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Diseases (AHA/ACC guidelines) provides specific guidelines that are applicable to the cardiac rehabilitation (CR) population.
Purpose: The purpose of this investigation is to evaluate gender specific compliance of CR patients completing CR with selected recommendations from the AHA/ACC Guidelines.
Design: The design of this investigation is a cross sectional design.
Methods: CR participants included in this investigation completed = 6 weeks of CR between 7/1/05 and 10/31/07 and had complete pre and post program labs, anthropometric measures, stress tests, and blood pressures available for analysis. There were 656 participants who met these requirements (26.1% females, 73.9% males). AHA/ACC guidelines selected for analysis included complete smoking cessation, BP < 140/90 mmHg or < 130/90 mmHg for diabetics, LDL-C < 100 mg/dl and non-HDL-C < 130 mg/dl if triglycerides = 200 mg/dl, body mass index (BMI) between 18.5 and 24.9 kg/m2 and waist circumference < 40 inches for men and < 35 inches for women, A1C < 7%, 100% of patients on aspirin therapy, 100% ACE/ARB therapy where LVEF < 40% or with hypertension, diabetes or chronic kidney failure, and 100% beta blocker therapy. Data were analyzed using chi square statistics.
Results: There were no statistically significant differences between men and women in the percentages at goal at the conclusion of CR for BP (85.8% men, 90.6% women), LDL-C (87.4% men, 81.3% women), BMI (16.7% men, 22.2% women), and waist (53.0% men, 44.0% women). However, there was a significant difference (P = .02) in the percentage of smokers by gender (6.2% males, 1.8% women). In addition, a significantly greater percentage of males (61.3%) achieved A1C goal compared to women (33.3%) (P = .006). No statistically significant gender differences were observed in medication therapy. A high percentage of both men (94.9%) and women (93.0%) were on aspirin therapy. Of the 5.6% of participants who were not on aspirin therapy, 74.0% of were on coumadin or other anticoagulant therapy. A high percentage of patients were on beta blocker therapy (81.4% men vs 80.1% women). Of the 656 participants, 87.3% met criteria for ACE/ARB therapy. Of those meeting criteria, 63.2% of females and 64.1% of males were on ACE/ARB therapy.
Conclusions: Proportions of CR participants meeting AHA/ACC Guidelines for medication therapy compare favorably to published benchmarks; however, opportunities for improvement exist regarding goals related to lifestyle change, particularly BMI targets.