Abstract
Background
Cardiac rehabilitation (CR) improves major adverse cardiac outcomes in patients recovering
from myocardial infarction. CR influences outcomes through attenuation of cardiac
risk factors, lifestyle changes, and biological effects on endothelial function. The
clinical profile and sex-specific outcomes with CR after coronary artery bypass grafting
(CABG) is less well defined.
Methods
This retrospective cohort study of consecutive patients undergoing elective or urgent
CABG was performed between 2014 and 2016 at a single site. Patients requiring concomitant
procedures were excluded. Patients received referral to a 12-week, 36-session CR program
standardized through the health care system and tracked via electronic health records.
Clinical data and complications during hospitalization were abstracted from Society
of Thoracic Surgeons (STS) registry and matched with 12-months outcomes from electronic
health records. Primary composite outcomes were mortality and STS-defined complications
within 12 months after CABG. Kaplan-Meier plots for mortality were generated from
conditional 6-month survival data.
Findings
Of 756 patients undergoing CABG, 420 met the eligibility criteria (mean age, 66 years).
Women (18%) had a similar cardiac risk profile to men except for a higher hemoglobin
A1c level and lower hematocrit before surgery. Women had similar extent of revascularization
to men but had higher rates of intraoperative (30% vs 8%; p < 0.001) and postoperative blood transfusions (43% vs 29%; p = 0.014) compared with men. Only 66% of women qualified for direct discharge to home
compared with 85% of men (p = 0.0003). Twelve-month mortality was 1.3% and 2%, respectively (p > 0.05). Half of the cohort got referred for CR, and 32% of men and 23% of women
underwent CR. Twelve-month composite outcomes did not differ by referral to cardiac
rehabilitation (odds ratio = 0.77; 95% CI, 0.36–1.64) or engagement with CR (odds
ratio = 0.67; 95% CI −0.05 to 0.086), adjusting for age, sex, body mass index, and
diabetes. Kaplan-Meier analysis found no significant difference in survival between
those who did and did not undergo CR. Men experienced increases in metabolic equivalents
(38%, P = 0.014), grip strength (11%, P < 0.0001), and sense of physical well-being (40.9%, P < 0.0001), whereas women experienced increases in aerobic exercise duration (15.5%,
P = 0.02) and a trend in improved sense for physical well-being (93.3%, P = 0.06).
Implications
Sex differences exist with CR after CABG. Future studies should confirm these findings
in larger cohorts and corroborate the effect on endothelial function and other biological
markers.
Keywords
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Article info
Publication history
Published online: May 13, 2022
Accepted:
April 7,
2022
Identification
Copyright
© 2022 Elsevier Inc.
