Women Face Significant Barriers in Cardiac Rehabilitation Access Despite Proven Health Benefits

People who participate in cardiac rehabilitation programs after a major cardiac event have improved quality of life and long-term cardiovascular health, yet significant differences exist in cardiac rehabilitation access, participation and outcomes for women compared to men according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement details these gaps and suggests evidence-based strategies to increase referral and completion rates for cardiac rehab programs among women with cardiovascular disease.

Cardiac rehabilitation is a proven intervention to improve cardiovascular health, offering benefits such as reduced hospital readmission rates, lower mortality rates and enhanced quality of life. These programs typically include aerobic exercise and strength training, nutrition counseling, weight management and cardiovascular disease risk factor management. People who participate in cardiac rehabilitation experience improvements in cardiovascular disease risk factors, including higher rates of tobacco cessation, greater reductions in blood pressure and cholesterol levels, and improvements in fasting glucose levels. Notably, women who participate in cardiac rehabilitation programs experience greater reduction in mortality as compared to men.

Despite the effectiveness of cardiac rehabilitation, women are significantly underrepresented in these programs. Women are less likely to be referred to cardiac rehabilitation, with referral rates varying substantially among different racial and ethnic groups according to one study. The research showed referral rates of 48% for white women, 34% for Black women and only 15% for Hispanic women. Overall enrollment rates for women are 36% lower than those for men. Women entering cardiac rehabilitation tend to be older and to have more co-existing medical conditions, such as high blood pressure, high cholesterol, Type 2 diabetes and obesity, than men.

Women face multiple individual and societal barriers that affect their ability to participate in or complete cardiac rehabilitation programs. These include caregiving responsibilities, transportation challenges, scheduling conflicts, financial constraints including lack of health insurance, and limited social support. Women from underrepresented racial or ethnic groups are more likely to cite cost as a barrier to cardiac rehabilitation compared to white women, including high copayments or transportation costs. Addressing psychosocial well-being is an important component of cardiac rehabilitation programs, as previous studies have found that women with cardiovascular disease are more likely to experience depression, anxiety and psychosocial distress compared to men, which can contribute to worse cardiovascular outcomes.

There is also a need to address the intersection of cancer and cardiovascular disease in women. Women with a history of breast or gynecologic cancers often have elevated cardiovascular disease risk, and certain cancer therapies have adverse cardiovascular effects that contribute to increased cardiovascular disease risk during and after treatment. The statement emphasizes the need to educate both cardiac rehabilitation health professionals and women with cancer and cardiovascular disease about these risks. Some cardiac rehabilitation programs for women include a broader range of exercise choices such as dance, yoga or tai chi, provide greater social interaction and psychosocial support, and address insecurity concerns that women may have about their appearance or physical abilities.

Increasing cardiac rehabilitation referral, participation and completion rates among women can lead to improved cardiovascular health and quality of life for women with cardiovascular disease. Suggested solutions include increasing awareness of the benefits of cardiac rehabilitation programs, implementing automatic referral systems combined with case management to ensure all eligible women receive a referral, expanding access and addressing barriers to participation by offering flexible schedules and hybrid programs combining in-person and virtual components, and providing tailored support to meet women's emotional, social and physical needs. The scientific statement was prepared by a volunteer writing group on behalf of multiple American Heart Association councils and committees.