Outcomes and cost of women-focused cardiac rehabilitation: A systematic review and meta-analysis. (June 2022)

• Record Type: Journal Article
• Authors: Mamataz, Taslima; Ghisi, Gabriela LM; Pakosh, Maureen; Grace, Sherry L
• Is Part Of: Maturitas. Volume 160(2022)
• Page Start: 32
• Page End: 60
• Publication Date: 2022-06
• Subjects: Cardiac rehabilitation -- Systematic review -- Mortality -- Heart disease risk factors -- Quality of life; CVDs Cardiovascular diseases -- CR cardiac rehabilitation -- INOCA ischemia with non-obstructive coronary arteries -- UC usual care -- AC active comparison -- QoL quality of life, MD, mean difference -- CI confidence interval; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2022.01.008
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: Women-focused cardiac rehabilitation programming comprises women-only sessions and/or tailored content. This first review of outcomes identified 28 studies in 44 centers across more than 10 countries. Meta-analyses of trials showed that women-focused cardiac rehabilitation resulted in a better quality of life than active comparison programs. Women-focused cardiac rehabilitation may also be associated with lower morbidity and some risk factors. The effects of women-focused programs on functional capacity were equivocal, because all cardiac rehabilitation models were of benefit. Abstract: Background: The aim of this systematic review was to investigate the effects of women-focused cardiac rehabilitation (CR) on patient outcomes and cost. Methods: Medline, PubMed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception through to May 2020. Primary studies of any design were included, with adult females with any cardiac diseases. "Women-focused" CR comprised programs or sessions with >50% females, or 1-1 programming tailored to women's preferences. No studies were excluded on the basis of outcome. Two independent reviewers rated citations for potential inclusion, and one extracted data, including on quality, which was checked independently. Random-effects meta-analysis was used where there were ≥3 trials with the same outcome; certainty of evidence for these was determined based on GRADE. For other outcomes, SWiM was applied. Results: 3498 unique citations were identified, of which 28 studies (52 papers) were included (3, 697 participants; 11 trials). No meta-analysis could be performed for outcomes with "usual care" comparisons. Compared to "active comparison" group, women-focused CR had no meaningful additional effect on functional capacity. Women-focused CR meaningfully improved physical (mean difference [MD]=6.37, 95% confidence interval [CI]=3.14-9.59; I 2 =0%; moderate-quality evidence) and mental (MD=4.66, 95% CI=0.21-9.11; I 2 =36%; low-quality evidence) quality of life, as well as scores on seven of the eight SF-36 domains. Qualitatively, results showed women-focused CR was associated with lower morbidity, risk factors, and greater psychosocial well-being. No effect was observed for mortality. One study reported a favorable economic impact and another reported reduced sick days. Conclusions: Women-focused CR is associated with clinical benefit, although there is mixed evidence and more research is needed. PROSPERO registration: CRD42020189760