INTRODUCTION AND OBJECTIVES:The effectiveness of cardiac rehabilitation (CR) in improving exercise capacity and quality of life (QoL) in heart failure (HF) is well established. However, it remains underutilized in women. We aimed to compare the adherence and effectiveness of a CR program in women and men with HF. METHODS:This was a prospective single-center study of consecutive 93 HF patients referred to a CR program between September 2019 and July 2021. We defined adherence as the percentage of sessions patients attended. Effectiveness outcomes were changes in peak oxygen uptake (VO2 peak) and QoL measurements before (baseline) and after the CR program (12wk). VO2 peak was assessed by a maximal effort cardiopulmonary exercise testing on a treadmill. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS:Among 93 patients, 32.3% were female. Regarding adherence, 84% of patients completed the CR program, and no significant differences were found between groups (p=0.232). The increase in VO2 peak did not differ between genders (p=0.938). A significant reduction in the total, physical and emotional MLHFQ scores in both genders was observed (all p<0.05). There were no significant differences in QoL effectiveness analysis between the groups (all p=NS). CONCLUSION:Women with HF adhered to the CR program similarly to men and had a similar increase in VO2 peak, a robust and validated prognostic marker for HF in this setting. Women benefited as much as men in all dimensions of QoL. Together, these data emphasize the need to increase the referral of women with HF to CR programs.

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is characterized by functional limitation and consequent loss of quality of life. These parameters can be measured through self-evaluated instruments, namely Duke activity status index (DASI) and Minnesota living with heart failure questionnaire (MLHFQ). In parallel, HF is also characterized by objective parameters measured by complementary diagnostic tests, namely NT-proBNP and left ventricular ejection fraction by echocardiogram. Patients with higher NT-proBNP value and worse ejection fraction may present with more symptoms and consequently functional impairment and worse quality of life. Aim To analyze if self-reported parameters present significant correlation with objective measured parameters and to understand if there are differences between gender in out-patients followed in advanced heart failure assessment. Methods During the year of 2022, a cohort of out-patients was analyzed. Data was collected regarding DASI, MLHFQ and disease stratification based on NT-proBNP and left ventricular ejection fraction by echocardiogram. Pearson's correlation was made between these parameters, trying to understand whether they were related to them and whether this relationship is in line with the patient's clinical presentation. An independent sample T-test was performed in order to understand any differences regarding the gender. Results A sample of 122 patients were evaluated; 97 (80%) were male, with a mean age of 63 years. New York Heart association functional class was between II and III and all patients had reduced left ventricular ejection fraction, with an average of 35% (min: 10% and max: 48%). NT-proBNP scores are quite high, presenting an average score of 1349.7±1482.5. Average score of MLHFQ was 13±15, meaning that patients present a good quality of life and DASI average score was 33.9±16.1, meaning a very acceptable functional capacity level. The DASI score correlates negatively with MLHFQ (r = -0.566, p = 0.003) and with NT-proBNP value (r = -0.783, p = 0.000); MLHFQ score is positively correlated with NT-proBNP value (r = 0.018, p = 0.000). A high DASI score corresponds to good functional capacity and, as such, better quality of life and lower physiological impact of the disease. Surprisingly, despite the lower MLHFQ and high DASI, patients present a quite increase level of NT-proBNP. There were no gender differences in relation to the DASI score (p = 0.077) and MLHFQ (p = 0.422). Conclusion The self-evaluated parameters correlate with the physiological parameters objectively measured. The perception of patients regarding their quality of life and functional capacity may not allow to infer about their physiological parameters, since a high NT-proBNP a low left ventricular ejection fraction normally indicates a worse functional level, which is not observed in this cohort of patients. Gender seems to have no impact on the level of quality of life or self-reported functional capacity.

Abstract Introduction Cardiac rehabilitation (CR) is a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF). Despite the robust evidence supporting its safety and benefits, there is an incomplete understanding of the reasons of the underutilization of CR programs in HFrEF. These reasons are complex and probably encompass healthcare system- and patient-level barriers. Purpose To study the clinical determinants and barriers to enrolment in a CR program for HFrEF patients. Methods We conducted a study of consecutive heart failure patients followed at a dedicated HFrEF cardiology clinic from January 2019 to April 2021. Patients were divided according to previous enrolment in CR program. Data were collected from electronic health records, and in case of missing data patients were asked by telephone about the reason for not participating in CR using a structured and validated questionnaire for this purpose. Results Of 228 patients with HFrEF, 60% had not been enrolled in a CR program; they were older (63 vs 58 years; p<0.01) and more likely to have comorbidities such as hypertension (56% vs 41%; p=0.03) or concomitant chronic obstructive pulmonary disease (20% vs 8%; p=0.01). Conversely, patients enrolled in CR programs were more likely to have a previous history of acute myocardial infarction (34% vs 20%; p=0.02). Regarding heart failure-related clinical features (NYHA functional class, LVEF, ICD/CRT), we did not find any significant differences between groups. The main reasons for not being enrolled in CR programs were: no medical referral (31%), concomitant medical problems (27%) such as musculoskeletal problems, patient refusal (11%) and geographical distance to the hospital (9%). Conclusion Despite the high proportion (40%) of HFrEF patients who underwent CR program compared to previous studies, the enrolment to CR can be further improved. The main barriers are related to health professionals (no referral), healthcare system (geographical distance to the hospital) and patients (concomitant noncardiac problems). Innovative strategies should target these factors to increase the delivery of CR program in HFrEF. Funding Acknowledgement Type of funding sources: None.

Abstract Introduction Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion. Methods We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices. Results Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p<0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS. Conclusion The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use. Funding Acknowledgement Type of funding sources: None.