Caulin-Glaser T, Blum M, Schmeizl R, Prigerson H G, Zaret B, Mazure C M
Division of Cardiovascular Medicine, Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, 3FMP, P.O. Box 208017, New Haven, CT 06520-8017, USA.
J Cardiopulm Rehabil. 2001 Jan-Feb;21(1):24-30. doi: 10.1097/00008483-200101000-00006.
This study examines the influence of gender on the healthcare provider's secondary prevention instruction and cardiac rehabilitation (CR) referral after coronary revascularization procedures such as balloon angioplasty/coronary stenting and coronary bypass surgery (CABG). Cardiac rehabilitation decreases mortality and morbidity, yet only a small percentage of women and men are referred to these programs. The patient population of our university-affiliated CR program consisted of 88% men and 12% women.
In a matched case observational study, 80 patients (40 men, 40 women) who had undergone coronary revascularization procedures between 1997 and 1998 completed a questionnaire on secondary prevention instruction and written referral to CR programs. Patients were matched for age and coronary revascularization procedure.
Women were less likely to be instructed on secondary prevention strategies and CR or referred to CR as compared to men despite being matched for age and undergoing the same procedure. The data demonstrate a gender difference in hospital teaching and referral information for CR after revascularization (P < 0.001). Being a woman was associated with a decreased likelihood of receiving a physician referral to CR after revascularization (P < 0.001).
The instruction of patients concerning secondary prevention and CR postrevascularization procedures is poor. Within that group, women were far less likely to have CR discussed or referrals made by healthcare professionals. This study demonstrates the need for education initiatives of all healthcare providers on the comprehensive nature and benefits of CR in the secondary prevention of cardiovascular disease, with a particular emphasis on women.
本研究探讨性别对医疗服务提供者在冠状动脉血运重建术（如球囊血管成形术/冠状动脉支架置入术和冠状动脉搭桥手术（CABG））后进行二级预防指导及心脏康复（CR）转诊的影响。心脏康复可降低死亡率和发病率，但只有一小部分男性和女性被转诊至这些项目。我们大学附属心脏康复项目的患者群体中男性占88%，女性占12%。
在一项匹配病例观察性研究中，80例在1997年至1998年间接受冠状动脉血运重建术的患者（40名男性，40名女性）完成了一份关于二级预防指导及心脏康复项目书面转诊的问卷。患者在年龄和冠状动脉血运重建术方面进行了匹配。
尽管在年龄上匹配且接受相同手术，但与男性相比，女性接受二级预防策略指导及心脏康复或被转诊至心脏康复项目的可能性更小。数据表明，血运重建术后在医院教学及心脏康复转诊信息方面存在性别差异（P < 0.001）。女性在血运重建术后获得医生转诊至心脏康复项目的可能性降低（P < 0.001）。
关于血运重建术后二级预防和心脏康复的患者指导情况较差。在该群体中，女性由医疗专业人员讨论心脏康复或进行转诊的可能性要小得多。本研究表明，需要对所有医疗服务提供者开展教育活动，使其了解心脏康复在心血管疾病二级预防中的全面性质和益处，尤其要重视女性。
