pa0705008.ppt - Wichita State University

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					                                Effectiveness of Cardiac Rehabilitation Programs in Females Following an Acute
                                                             Myocardial Infarction
                                                            *Katie Carnelia PA-S and **Kenneth H. Pitetti, Ph.D
                                                    *Department of Physician Assistant, ** Department of Physical Therapy
                                                                    Wichita State University, Wichita, KS
                  INTRODUCTION                                                  RESULTS                                                                               DISCUSSION
In order to decrease morbidity and mortality                 • A total of 21 articles met inclusion criteria                     The results of the literature suggest females benefit
associated with myocardial infarctions (MI), cardiac         •Direct Comparison between genders and CRP outcome, n=9.            from CRP, including reduction of subsequent cardiac
rehabilitation programs (CRP) offer a viable option for        Address specific parameters of CRP which illustrate females       events, but not to the same degree as males.
improving physical capacity, reducing emotional                are benefiting from CRP but often not to the same degree as       However, it is suggested that females could benefit
distress, and modifying risk factors. Unfortunately,           their male counterparts.                                          from CRP to a greater degree since they start at a
many eligible patients are not referred or do not utilize    •Indirect relationship of CRP outcome addressed through referral    lower functional capacity. Multiple articles suggest a
CRP [1-4] despite the demonstrated benefits. [3,4] A         and utilization patterns, n=6                                       CRP designed specifically for the unique needs of
primary concern is determining if current CRP are as           Focus on referral and utilization rates for CRP between           females. Areas of potential CRP improvement
effective for females as males. The focus of CRP               genders. which support the problem that females are less likely   include physical, such as exercise capacity,
have always tended to favor males, particularly since          than males to be referred to, utilize, or adhere to CRP.          emotional, such as stress adaptation, and
cardiovascular disease is more often associated with         •Background information regarding CRP indications and potential     psychological, such as lower levels of depression
males, despite evidence of cardiovascular disease as         benefits, n=6.                                                      and anxiety. Despite demonstrated benefits, more
a leading cause of morbidity and mortality in both             Illustrate the need for MI patients to use CRP, however they do   studies should be conducted with a larger focus on
genders. [5-7] Given that “Optimal treatment is not            not address the specific/quantitative outcome differences         the needs of females, including insecurities as well
necessarily the same treatment for all,” [7] differences       between genders.                                                  as physical shortcomings and emotional limitations
exist between male and female patients who suffer            •Articles excluded for lack of relevancy to the question/problem
from an MI. For instance, males frequently present           or when outcome was not divided by gender, n=5                                                        CONCLUSIONS
with the defined, classical symptoms of an MI (i.e.,         •Overall grade based on levels of evidence – B                      While the incidence of MI is increasing in females,
chest pain, pain down the left arm and shortness of                                                                              the present CRP practices still fail to understand and
                                                               Breakdown of Levels of Evidence: Level 1 n= 7,
breath) during the 6th or 7th decade of life. On the                                                                             address the multidimensional differences between
                                                               Level 2 n= 10, Level 3 n= 4
other hand, females usually do not present with these                                                                            males and females in terms of responding to and
classical symptoms but rather more nonspecific               Figure 1 - Literature Review Diagram                                adhering to CRP. Since clinical profiles vary from
symptoms (atypical chest pain and concurrent                                                                                     males and females in that females present at an
comorbidities like hypertension and diabetes) do not                                                                             older age with more comorbidities, a more
usually occur until the 8th or 9th decade. Knowing                                                                               specialized CRP for females may be more effective.
this, it is vital to assess the effectiveness of current                                                                         As was illustrated in this review, females do benefit
CRP to determine if females are receiving the                                                                                    from CRP, even though the extent is unclear since
maximal benefit.                                                                                                                 females have not been the focus of many high-
                                                                                                                                 quality studies. Therefore, it is important for health
                                                                                                                                 care professionals to recognize the unique needs of
                      METHODS                                                                                                    females     so    optimal     cardiac     rehabilitation
A systematic literature review was performed to identify                                                                         opportunities are encouraged in order to minimize
evidence-based       research        addressing     gender                                                                       the negative effects of an MI.
differences in mulitple areas of CRP including clinical
presentation,     referral/utilization    patterns,    and                                                                                                           REFERENCES
                                                                                                                                  [1]Mitchell R, Muggli M, Sato A. Cardiac rehabilitation: participating in an exercise program in a quest to
outcomes. The following electronic databases were                                                                                     survive. Rehabil Nurs. Nov-Dec 1999;24(6):236-239.
                                                                                                                                  [2] Heid G, Schmelzer M. Influences on women's participation in cardiac rehabilitation. Rehabilitation
searched for articles from 1986 to 2006: MedLine,                                                                                     Nursing. 2004;29(4):116-121.
                                                                                                                                  [3] Moore S, Dolansky M, Ruland C, Pashkow F, BLackburn G. Predictors of women's exercise
CINHAL, PyschInfo and Cochrane.             The following                                                                             maintenance after cardiac rehabilitation. J Cardiopulmonary Rehabil. 2003;23:40-49.
                                                                                                                                  [4] Beswick A, Rees K, West R, et al. Improving uptake and adherence in cardiac rehabilitation: Literature
MeSH terms were used to identify articles: cardiac                                                                                    review. J of Advanced Nursing. 2004;49(5):538-555.
                                                                                                                                  [5] Halm M, Penque S, Doll N, Beahrs M. Women and cardiac rehabilitation: Referral and compliance
                                                                                                                                      patterns. J of Cardiovascular Nursing. 1999;13(3):83-92.
rehabilitation,   gender       differences,    compliance,                                                                        [6]Deshotels A, Planchock N, Dech Z, Prevost S. Gender differences in perceptions of quality of life in
                                                                                                                                      cardiac rehabilitation patients. J Cardiopulm Rehabil. Mar-Apr 1995;15(2):143-148.
effectiveness, myocardial infarction, women, females                                                                              [7] Burell G, Granlund B. Women's hearts need special treatment. Internation J of Behavioral Medicine.
and outcomes.

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