Galdas Paul Michael, Harrison Alexander Stephen, Doherty Patrick
Department of Health Sciences, Faculty of Science, University of York, York, UK.
Open Heart. 2018 Mar 27;5(1):e000764. doi: 10.1136/openhrt-2017-000764. eCollection 2018.
To determine whether there are gender differences in the factors that predict attendance at the initial cardiac rehabilitation baseline assessment (CR engagement) after referral.
Using data from the National Audit of Cardiac Rehabilitation, we analysed data on 95 638 patients referred to CR following a cardiovascular diagnosis/treatment between 2013 and 2016. Eighteen factors that have been shown in previous research to be important predictors of CR participation were investigated and grouped into four categories: sociodemographic factors, cardiac risk factors, patient medical status and service-level factors. Logistic binary regression models were built for male patients and female patients, assessing the likelihood for CR engagement. Each included predictors such as age, number of comorbidities and social deprivation score.
There were no important differences in the factors that predict the likelihood of CR engagement in men and women. Seven factors associated with a reduced probability of CR engagement, and eight factors associated with increased probability, were identified. Fourteen of the 15 factors identified as predicting the likelihood for engagement/non-engagement were the same for both men and women. Increasing age, being South Asian or non-white ethnicity (other than Black) and being single were all associated with a reduced likelihood of attending an initial CR baseline assessment in both men and women. Male patients with diabetes were 11% less likely to engage with CR; however, there was no significant association in women. Results showed that the overwhelmingly important determinant of CR engagement observed in both men and women was receiving an invitation to attend an assessment session (OR 4.223 men/4.033women; p<0.05).
Consideration of gender differences in predictors of CR uptake should probably be more nuanced and informed by the stage of the patient care pathway.
确定在转诊后预测首次心脏康复基线评估（心脏康复参与度）的因素中是否存在性别差异。
利用心脏康复国家审计的数据，我们分析了2013年至2016年间因心血管诊断/治疗而被转诊至心脏康复的95638名患者的数据。研究了先前研究中已表明是心脏康复参与重要预测因素的18个因素，并将其分为四类：社会人口统计学因素、心脏危险因素、患者医疗状况和服务水平因素。为男性患者和女性患者建立了逻辑二元回归模型，评估心脏康复参与的可能性。每个模型都纳入了年龄、合并症数量和社会剥夺分数等预测因素。
在预测男性和女性心脏康复参与可能性的因素方面没有重要差异。确定了7个与心脏康复参与概率降低相关的因素和8个与概率增加相关的因素。在确定为预测参与/不参与可能性的15个因素中，有14个对男性和女性都是相同的。年龄增加、为南亚或非白人种族（非黑人）以及单身都与男性和女性参加首次心脏康复基线评估的可能性降低相关。患有糖尿病的男性患者参与心脏康复的可能性低11%；然而，女性患者中没有显著关联。结果表明，在男性和女性中观察到的心脏康复参与的最重要决定因素是收到参加评估会议的邀请（男性比值比4.223/女性比值比4.033；p<0.05）。
在考虑心脏康复接受度预测因素中的性别差异时，可能应该更细致入微，并根据患者护理路径的阶段来提供信息。
