(P231) ASSOCIATIONS OF BIOLOGICAL SEX WITH CARDIAC REHABILITATION UTILIZATION AND PROGRAM OUTCOMES BEFORE VS DURING THE COVID-19 PANDEMIC

Background: Cardiac Rehabilitation (CR) is an evidence-based form of secondary prevention used to improve outcomes in cardiovascular disease patients. The COVID-19 pandemic challenged the healthcare system’s ability to deliver care. Many CR programs had to transition to virtual delivery. There has been a call by the Canadian Women’s Heart Health Alliance to improve the evidence base for the treatment of women’s heart disease. Our study aimed to investigate whether biological sex was associated with CR utilization or program outcomes, before vs. during the COVID-19 pandemic.

METHODS AND RESULTS: Data was retrospectively extracted from patient medical records from a single CR program. Two cohorts of post-percutaneous coronary intervention (PCI) patients were compared: those enrolled in CR before the pandemic (PRE; 2017 to 2019; n = 180 females and 526 males) vs during the pandemic (PAN; 2020 to 2022; n = 152 females and 362 males). Groups were further stratified by sex. CR enrollment decreased by 27.2% in PAN vs PRE (p < 0.01). Males had a disproportional PAN decrease in CR enrollment vs females leading to a non-significant increase (p = 0.1) in the proportion of females vs males attending CR intake during the pandemic (PRE 25.5% vs PAN 29. 6% of patients were female). VO2peak did not change significantly from CR intake to discharge in the female PRE group (1150 vs 1153 ml/min), however, it improved significantly in all other groups (i.e., male PRE [1886 vs 2035 ml/min], female PAN [1183 vs 1268 ml/min], male PAN [1884 vs 2011 ml/min]; p < 0.01) at discharge. The percent of patients above the non-HDL-C threshold (>2.19 mmol/L) at intake vs discharge was similar in female PRE (51.1% vs 53.6%) and male PRE (42.6% vs 43.1) groups and reduced at discharge in female PAN (76.5 % vs 41.7%) and male PAN (64.2% vs 33.2%) groups. Compared to PRE males and females, PAN males and females had improvements in the number of patients with non-HDL-C levels above threshold at discharge (p < 0.01).

Conclusion: During the pandemic, while overall enrollment of post-PCI patients decreased, there was an increase in the proportion of females vs males attending CR. There was no significant change in VO2peak and non-HDL-C in PRE females during CR, however, PAN females had improvements in both parameters. This increase in the proportion of females utilizing CR, and the improvement in CR outcomes in female patients during the pandemic may be attributable to the virtual nature of CR.