Gender Differences and Long Term Outcome of Over 75 Elderlies in Cardiac Rehabilitation: Highlighting the Role of Psychological and Physical Factors through a Secondary Analysis of a Cohort Study

Background: Despite cardiac rehabilitation for elder people already showed its usefulness, to date it is still not clear the impact of gender and of psychological constructs in influencing the rehabilitation outcomes. Aim: This study aimed at exploring the gender differences of great elders (over 75 years old) in cardiac rehabilitation, with particular attention to the impact of physical and psychological conditions, as depressive symptoms, on long-term post-discharge outcomes. Design: A cohort study design was used and a secondary analysis was conducted. Setting: Cardiac rehabilitation unit of a post-acute rehabilitation Institute. Population: Elderly patients over 75 years old admitted to the cardiac rehabilitation program. Methods: Psychological and functional variables, such as Barthel Index, BMI, quality of life, and depression measured at admission and discharge from CR were matched with mortality information up to 4 years, used as long-term outcomes. Results: 523 patients, 228 females and 295 males, with a mean age of 76.27 years ± 3.46 were progressively enrolled. Barthel index at admission and discharge was higher for males than females, 74.10 ± 17.31 vs 68.90 SD ± 16.81 (p < .001), and 95.45±10.64 vs 92.95±13.03 (p = 0.021), respectively, while the relative change from admission to discharge Δ% of Barthel was higher for females 0.25±0.18 than for males 0.21±0.17 (p < 0.05). Compared to males, either at admission or discharge females presented more severe depressive symptoms (5.21±3.46 vs 3.86±2.79, p<0.001; 4.15±3.21 vs 2.93±2.45, p < 0.001) and a worse quality of life (10.58±2.15 vs 9.55±2.24, p<0.001; 7.5±1.63 vs 7.02±1.08, p=0.018). Cox proportional analysis revealed that female gender, depression at discharge, Barthel, and Comorbidity Index were associated with higher hazard and shorter survival time. On the other hand, higher BMI was associated with lower hazard and longer survival time. Conclusions: Elderly women following a CR program present more disability, depression, and a worse QoL than men. Obviously, these characteristics influence the length of hospitalization but with significant improvement. Despite the frail-gender paradox regarding survival, after CR program women have a higher risk of mortality than men. Depression has a significant negative impact on elderly psychophysical health. Clinical rehabilitation impact: Gender-specific and individualized rehabilitation programs should be implemented by considering the discussed physical and psychological risk factors. Further insight about gender differences among over 75 elderlies in CR is provided, this knowledge may be useful for clinicians scheduling recovery plans to promote elderlies' psychological and physical health. Psychological interventions should be implemented to relieve the depressive symptoms among elders.