Women Face Significant Barriers in Cardiac Rehabilitation Access Despite Proven Health Benefits
A new scientific statement reveals women face substantial obstacles in accessing cardiac rehabilitation programs despite experiencing greater mortality reductions than men, highlighting urgent need for systemic changes to improve cardiovascular outcomes for female patients.
Women experience significant disparities in accessing and completing cardiac rehabilitation programs despite proven benefits for cardiovascular health, according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement details how women are less likely to be referred to cardiac rehab, face multiple barriers to participation, and have lower completion rates compared to men, despite evidence showing they experience greater mortality reductions from these programs.
Cardiac rehabilitation is a proven intervention that improves cardiovascular health through aerobic exercise, strength training, nutrition counseling, weight management, and cardiovascular disease risk factor management. Participants show reduced hospital readmission rates, lower mortality rates, and enhanced quality of life. People who complete 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.
Despite these benefits, women are substantially underrepresented in cardiac rehabilitation programs. Women are less likely to be referred to cardiac rehab, with referral rates varying significantly among different racial and ethnic groups. According to one study cited in the statement, referral rates were 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, creating a significant gap in care access.
Women entering cardiac rehabilitation tend to be older and have more co-existing medical conditions than men, including high blood pressure, high cholesterol, Type 2 diabetes, and obesity. They also face numerous individual and societal barriers that affect their ability to participate in or complete programs. Caregiving responsibilities, transportation challenges, scheduling conflicts, financial constraints including lack of health insurance, and limited social support all contribute to lower participation rates. Women from underrepresented racial or ethnic groups are more likely to cite cost as a barrier compared to white women.
The statement emphasizes that addressing psychosocial well-being is a critical component of cardiac rehabilitation programs. Women with cardiovascular disease are more likely to experience depression, anxiety, and psychosocial distress compared to men, which can contribute to worse cardiovascular outcomes. The scientific statement was prepared by a volunteer writing group on behalf of several American Heart Association councils and committees. Additional financial information about the Association is available here.
Some specialized cardiac rehabilitation programs for women include broader 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. However, evidence remains mixed about whether programs tailored specifically to women's preferences are more effective than traditional co-ed programs.
The scientific statement suggests multiple strategies to increase cardiac rehabilitation referral, participation, and completion rates among women. These include increasing awareness of program benefits, implementing automatic referral systems combined with case management, expanding access through flexible schedules and hybrid programs combining in-person and virtual components, and providing tailored support to meet women's emotional, social, and physical needs. Improving access to these evidence-based programs could lead to significant improvements in cardiovascular health and quality of life for women with cardiovascular disease.