Key result
In heart transplant patients undergoing cardiac rehabilitation, female sex was associated with a lower incidence of the primary composite outcome and reduced mortality (HR 0.164; 95% CI 0.038-0.716; P=0.0161).
Why the study?
Cardiac rehabilitation shows promise after heart transplantation, but the impact of biological sex in this setting remains uncertain.
Does female sex improve long-term outcomes (death, allograft rejection, or cardiac allograft vasculopathy) compared to male sex in heart transplant patients admitted to cardiac rehabilitation?
Cohort (n=129)
Yes
Does female sex improve long-term outcomes (death, allograft rejection, or cardiac allograft vasculopathy) compared to male sex in heart transplant patients admitted to cardiac rehabilitation?
Female heart transplant recipients admitted to cardiac rehabilitation have a significantly lower incidence of death, allograft rejection, or cardiac allograft vasculopathy at 30 months compared to males.
Answers are grounded in this paper and cite their sources.
Female sex may inform risk stratification in post-transplant rehabilitation; leaves open prospective validation and sex-specific interventions.
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.
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Tedeschi et al. (2024) conducted a cohort in Heart transplantation (n=129). Female sex vs. Male sex was evaluated on Composite of death, allograft rejection, or cardiac allograft vasculopathy (HR 0.164, 95% CI 0.038-0.716, p=0.0161). In heart transplant patients undergoing cardiac rehabilitation, female sex was associated with a lower incidence of the primary composite outcome and reduced mortality (HR 0.164; 95% CI 0.038-0.716; P=0.0161).
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