Does gender affect the outcomes of patients in program of managed care for acute myocardial infarction.
Katarzyna Wilkosz, Maciej Wybraniec, Marcin Wita and 5 others
PMID 34086057WHAT IT FOUND
After one year in a cardiac rehabilitation programme, women and men had similar rates of death, recurrent heart attack or heart-failure hospitalization: 11.38% vs 11.33%.
Being female was not a significant risk factor.
Key findings
01The primary composite outcome of death, recurrent myocardial infarction or heart-failure hospitalization occurred in 11.38% of women and 11.33% of men, with no significant difference (p = 0.98).
02Female sex had a hazard ratio of 0.71 for major adverse cardiovascular events (95% CI 0.49-1.03), but the association did not reach statistical significance (p = 0.07).
03Cox multivariate analysis reported coronary heart disease, diabetes mellitus type II, and previous percutaneous coronary intervention as significantly correlated with the primary endpoint.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Single-centre prospective cohort, so results may not apply to other settings or health systems. No control group outside the MC-AMI programme, so the study cannot show that the programme or any component caused the outcomes. The programme had multiple components at once, including supervised physical training, psychological sessions, education, and follow-up, so the contribution of physical training alone cannot be separated. Only 167 women were analysed, and the authors state the number of cases was limited, so sex differences or small effects could be missed. Follow-up was 12 months, and the primary endpoint was a composite of death, recurrent myocardial infarction and heart-failure hospitalization, not physical function or therapy-specific outcomes. The paper says baseline age and comorbidities were comparable, while Table I reports chronic kidney disease with p = 0.027, so baseline balance is unclear. Women were underrepresented in the programme (31.6% of participants), which limits generalisability to female patients who do not enter cardiac rehabilitation.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the hazard ratio of 0.71 for female sex as proof that women have better outcomes in this programme. The primary major adverse cardiovascular event outcome was not significantly different (p = 0.98), the sex association did not reach significance (p = 0.07), the study had no control group, and the programme combined supervised exercise, psychological sessions, education and follow-up.