Chacin-Suarez, A

Abstract Background The United States Department of Health and Human Services has defined 21 chronic conditions lasting one year or greater and which require ongoing medical treatment. The presence of multiple chronic conditions (multimorbidity) is closely linked to greater physical disability, increased health care utilization, reduced quality of life, and higher mortality rates. In the general population, studies have shown the prevalence of multimorbidity to be greater in females compared to males. Recently, data has suggested that patients enrolled in cardiac rehabilitation (CR) have a significantly greater number of chronic conditions compared to the general population. Whether these same sex differences in the prevalence of individual chronic conditions are present in the CR population has not been examined. Purpose The purpose of this study is to determine whether differences exist in the prevalence of individual chronic conditions between male and female CR patients. We hypothesize that female CR patients will demonstrate greater prevalence of individual chronic conditions compared to men. Methods Using the local Epidemiology Project records-linkage system, we identified patients who attended (≥1) CR sessions from 1995-2019. The prevalence of 21 chronic conditions was extracted from the patients’ medical records at the time of enrollment in CR (Table 1). We conducted chi-squared analysis to identify differences in the prevalence of each individual chronic condition between the sexes. Statistical significance was defined by p≤0.05. Results Of the 13,056 CR patients identified (age: 65.7±12.8 yrs old), 4,107 (31.5%) were female. Male CR patients were significantly younger compared to female counterparts (64.8±12.1 yrs old vs. 67.6±13.6 yrs old; p≤0.001). Females demonstrated a greater number of total chronic conditions compared to males (median (IQR): 7.0 (5.0, 9.0) vs 6.0 (5.0, 8.0); p≤0.001). Females demonstrated a greater prevalence of the following 12 individual chronic conditions compared to males: HTN, CHF, ARR, STR, ART, CAN, CPD, HEP, OST, ANX, DEM, and DEP (p≤0.05, for all). There was a trend for greater prevalence of ARR in females compared to males (p=0.07). In contrast, males experienced a greater prevalence of the following four chronic conditions compared to females: CAD, LIP, AST, and SUB (p≤0.001, for all). There were no differences between sexes for CKD (p=0.87), SZO (p=0.70), or AUT (p=0.31). Conclusion Our data suggest the trend for greater prevalence of chronic conditions in females in the general population is consistent within the CR population. Specifically, 12 of 21 (57%) individual chronic conditions were significantly more prevalent in female CR patients whereas only 4 (19%) conditions were more prevalent in males. These data emphasize the need to better understand the relationship between sex and risk for individual chronic conditions, particularly in patients enrolled in CR.

Abstract Background Patients enrolled in cardiac rehabilitation (CR) demonstrate a greater burden of co-occurring chronic conditions (CC) compared to the general population. Studies have shown that the prevalence of multimorbidity among noninstitutionalized, civilian US adults is higher among women compared to men. These CC are often grouped and categorized as Cardiometabolic, Somatic, and Mental Health based on the origin and organ system the condition affects. Importantly, sex differences between categorizations of CC in patients undergoing CR has not been examined. Purpose Because patients enrolled in CR are known to have multiple Cardiometabolic conditions, the aim of this study is to examine sex differences in the prevalence of non-cardiometabolic conditions in the CR population. Methods We extracted data on all 21 CC defined by the US Department of Health and Human Services using the local Epidemiology Project records-linkage system. Our study population included participants who attended (≥1) CR sessions from 1995 to 2019. The CC were categorized into cardiometabolic (CMC), Somatic, and Mental health groups (Table 1), and as CMC only, CMC + Somatic only, CMC + Mental health only, and CMC + Somatic + Mental health groups (Table 2). The sex differences in the number of CC within these groups were analyzed by Kruskal-Wallis test and prevalence were analyzed by Pearson’s Chi-squared test, where p<0.05 was significant. Results We identified 13,056 CR patients (68.5% males) who were ≥18 years old with a mean age of 65.7±12.7 yrs (67.6±13.6 yrs in females and 64.8±12.1 yrs in males). Median [Q1, Q3] number of CC was 7 [5,9], with females having a greater number (7 [5, 9]) than males (6 [5,8]), p<0.001. Both sexes had at least 1 CMC with a median of 5 [3,5] CMC and no differences between sexes (p>0.05); however, females demonstrated more somatic and mental health conditions compared to males (p<0.001, for both, Table 1). When grouping categories of CC, females demonstrated a higher number of CC in CMC + Somatic + Mental health as well as CMC + Somatic only groups (p<0.001, for both, Table 2), with a higher prevalence in the former group only. While the number of CC in CMC + Mental health group was similar between sexes, the prevalence was lower in females. In contrast, the CMC only grouping demonstrated a higher number of CC and prevalence among males (p<0.05). Conclusion Our data suggest that females enrolled in CR demonstrate a significantly higher number of CC compared to males. Although males have a higher prevalence of CMC, the prevalence of Somatic ± Mental health conditions in addition to CMC is significantly greater in females. These data demonstrate the importance of considering sex differences in the prevalence of non-CMC when formulating individualized treatment plans for CR patients.

Abstract Funding Acknowledgements Type of funding sources: None. Background Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States, including those with cardiovascular disease. Cardiac rehabilitation (CR) helps to optimize functional capacity, strength, and balance in patients with cardiovascular disease and, in theory, may reduce the risk of falls. However, little evidence has been published in this regard. Purpose The purpose of this study was to assess the association between CR participation and risk of falls in a community-based sample of individuals 65 years of age and older with cardiovascular disease who were eligible for CR participation. Methods Individuals from Southeastern MN and Western WI, USA, 65 years of age and older who had experienced a cardiovascular event that qualified them for CR (MI, PCI, CABG, Valve Surgery, Transplant) between January 1, 2000, and December 31, 2018, were included in this study. Participation in CR (≥1 sessions, CR-group) and subsequent falls (moderate or severe, using the Campbell classification system) were ascertained using the Rochester Epidemiology Project records-linkage system. Logistic model to create propensity weighting were used to test the association between CR participation and falls after adjustment for potentially confounding factors. Results A total of 5004 individuals met inclusion criteria for the study, with 2183 (44%) included in the CR group and 2821 (56%) in the non-CR group (CR was indicated, but the individual did not participate). Overall, 1122 patients experienced a fall within the first 5 years (16% of those in the CR-group, 23% of those in the non-CR group). After adjustment, CR participation was not associated with falls, but older individuals, females, and those with a history of falls were more likely to have had a fall, compared to young individuals, males, and those without a history of a fall. Conclusions While CR is beneficial for patients with cardiovascular disease, our study did not find evidence of an association between CR participation and fall risk in individuals 65 years of age and older who have cardiovascular disease. Additional research is needed to evaluate the role of CR components that may potentially reduce modifiable risk factors for falls and thereby reduce the risk of falls.