Colella Tracey J F, Gravely Shannon, Marzolini Susan, Grace Sherry L, Francis Judith A, Oh Paul, Scott Lisa Benz
University of Toronto, Toronto, Canada
University of Toronto, Toronto, Canada.
Eur J Prev Cardiol. 2015 Apr;22(4):423-41. doi: 10.1177/2047487314520783. Epub 2014 Jan 28.
Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in cardiac rehabilitation (CR), programmes which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists.
We searched Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases for studies reporting CR referral rates in women and men published between July 2000 and July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on predefined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE.
Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) met the inclusion criteria. In the pooled analysis, women (39.6%) were significantly less likely to be referred to CR compared to men (49.4%; odds ratio 0.68, 95% confidence interval 0.62-0.74). Heterogeneity was considered significant (I (2 )= 90%). There was no change in significant findings when subgroup analyses were conducted, examining fee for service vs. no fee, high-quality studies vs. others, or studies pooled by different study methodologies.
CR referral remains low for all patients, but is significantly lower for women than men. Evidence-based interventions to increase referral for all patients, including women, need to be instituted. It is time to ensure broader implementation of these strategies.
心血管疾病仍然是全球男性和女性发病和死亡的主要原因之一。然而，研究表明，在心脏康复（CR）项目中女性的参与率明显偏低，而这些项目已被证明可以减少心脏事件复发和相关的过早死亡。然而，转诊率的性别差异尚未得到系统和定量的综述。因此，本研究的目的是评估是否存在显著的性别差异。
我们在Scopus、MEDLINE、CINAHL、PsycINFO、PubMed和Cochrane图书馆数据库中搜索2000年7月至2011年7月期间发表的关于报告男性和女性CR转诊率的研究。对标题和摘要进行筛选，并根据预先定义的纳入/排除标准对选定的全文文章进行独立筛选。使用STROBE对纳入的文章进行质量评估。
在筛选的623篇文章中，19项观察性研究报告了241,613名参与者（80,505名女性）的数据，符合纳入标准。在汇总分析中，与男性（49.4%）相比，女性（39.6%）被转诊至CR的可能性显著降低（优势比0.68，95%置信区间0.62 - 0.74）。异质性被认为显著（I(2)=90%）。在进行亚组分析时，检查服务收费与不收费、高质量研究与其他研究，或按不同研究方法汇总的研究时，显著结果没有变化。
所有患者的CR转诊率仍然较低，但女性明显低于男性。需要制定基于证据的干预措施，以提高包括女性在内的所有患者的转诊率。现在是确保更广泛实施这些策略的时候了。
