Women missing cardiac rehab despite key benefits, study finds

Women are underutilising cardiac rehabilitation programmes despite clear evidence they reduce hospital readmissions and the risk of future heart attacks, new research shows.

Even when women do join these exercise, lifestyle and education programmes after heart surgery or major cardiovascular events, they are less likely than men to complete them.

An American Heart Association scientific statement  highlights the benefits of cardiac rehabilitation, barriers to access, and potential ways to increase participation among women.

It was co-authored by Jessica Golbus, a cardiologist at the University of Michigan Health Frankel Cardiovascular Center.

Cardiac rehabilitation combines supervised exercise sessions, education about heart-healthy living, and counselling to reduce stress and improve mental health following a cardiac event.

Patients typically attend several sessions a week for multiple weeks or months.

Golbus said: “Even when women do participate, the research tells us that they are still less likely to complete cardiac rehabilitation as compared to men.

“There are several barriers that women face to accessing cardiac rehabilitation, and existing programmes may fail to adequately address their specific needs.”

Women are referred for cardiac rehabilitation less often than men, with clinicians less likely to discuss it with female patients.

This gap is even wider among women from underrepresented racial groups.

Other barriers include insurance coverage, transportation problems, social isolation and caring responsibilities.

Women are more often the primary caregivers in families, which can make attending regular sessions difficult.

Research shows women who do take part benefit just as much as men — with lower blood pressure, better cholesterol levels and an improved quality of life.

Golbus said: “There is so much research that shows how cardiac rehabilitation is an essential tool for patients to optimise their recovery.

“I would encourage anyone who thinks they might be eligible for cardiac rehabilitation to talk to their clinical team and consider participating.”

Women recovering from cardiac events often have specific needs that existing programmes do not always meet.

They are more likely than men to experience depression and emotional distress after a heart event, and tend to be older at diagnosis, with additional health conditions that may restrict their exercise capacity.

They are also more likely to be referred following less common cardiovascular conditions such as coronary artery dissection — a tear in the wall of a heart artery — rather than the more typical heart attacks that usually lead to referral.

Golbus said: “Despite women having some unique needs, the research supports that all patients that qualify for cardiac rehabilitation have the potential for benefit.”

The statement outlines several ways to close the participation gap.

Automatic referral systems could significantly boost enrolment, while direct recommendations from physicians or case manager support have been shown to improve awareness and attendance.

Golbus said: “All of this points to a clear need for targeted interventions to improve cardiac rehabilitation participation and outcomes among women.

“I think the approach needs to be multi-faceted.”

Tailored programmes for women could help — such as offering a wider range of exercise options, more focused education and stronger psychosocial support.

Peer support groups after cardiac diagnoses are also linked to better quality of life and lower depression and anxiety scores.

Golbus said: “Women may also benefit from a peer support group after a cardiovascular diagnosis or event.

“Participating in those groups is linked to increased quality of life and lower depression and anxiety scores, which all affect cardiac rehab attendance.

“Finally, there is reason to explore virtual cardiac rehab that incorporates digital health technologies.

“This could eliminate the need for transportation to sessions and potentially improve access for patients who are unable to attend centre-based cardiac rehabilitation.”