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. 2024 Oct 17:23:200345.
doi: 10.1016/j.ijcrp.2024.200345. eCollection 2024 Dec.

Impact of biological sex on heart transplant patients admitted to cardiac rehabilitation: A 10-year retrospective cohort study

Andrea Tedeschi  1 , Ignazio Cusmano  2 , Francesca Di Salvo  2 , Letizia Oreni  2 , Anastasia Toccafondi  2 , Monica Tavanelli  2 , Paola Grati  2 , Luca Mapelli  2 , Luisa Arrondini  2 , Gianmarco Cannadoro  2 , Matteo Gonella  2 , Chiara Barcella  2 , Leone Stilo  2 , Alessandro Verde  3 , Gabriella Masciocco  3 , Giacomo Ruzzenenti  3 , Marco Biolcati  3 , Andrea Garascia  3 , Nuccia Morici  2
Affiliations

Impact of biological sex on heart transplant patients admitted to cardiac rehabilitation: A 10-year retrospective cohort study

Andrea Tedeschi et al. Int J Cardiol Cardiovasc Risk Prev. .

Abstract

Introduction: Heart transplantation (HTx) serves as the gold-standard therapy for end-stage heart failure, yet patients often experience physical deconditioning and cognitive impairments post-surgery. Cardiac rehabilitation (CR) has shown promise in the HTx context. However, uncertainty surrounds the impact of biological sex. Accordingly, the aim of this paper was to investigate the impact of biological sex in a cohort of patients with HTx early admitted to a residential CR program.

Methods: This was a retrospective analysis involving patients who underwent HTx at Niguarda Hospital and who subsequently participated in a CR program at IRCCS Fondazione Don Gnocchi, Milan, Italy, between 2010 and 2022. The primary endpoint was time to event (in months), with an event defined as a composite outcome of whichever occurred first of death, allograft rejection, or cardiac allograft vasculopathy up to 30 months follow-up.

Results: In a total of 129 patients, 60 % male, and 40 % female, baseline characteristics presented comparably between the sexes. At 6 months, no significant sex differences were observed for the primary composite outcome. However, at 30 months, females exhibited a significantly lower incidence of the primary composite outcome and an increased survival rate. Multivariable analysis confirmed a protective effect of female sex against mortality (F vs. M, HR 0.164, 95 % CI 0.038-0.716, P = 0.0161).

Conclusions: Despite limitations, our findings emphasize that sex affects post-HTx long-term follow-up following CR discharge, with more favorable outcomes for female recipients. In an era of tailored management algorithms, it is imperative to take into account the gender gap even in cardiac rehabilitation.

Keywords: Cardiac rehabilitation; Gender gap; Heart transplant.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Flow diagram illustrating the selection of the study population.
Fig. 2
Fig. 2
Comparison between male and female sex in terms of population characteristics and of survival probabilities at 6 and 24 months of follow-up.
See this image and copyright information in PMC

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