Women experience significant disparities in accessing and completing cardiac rehabilitation programs despite proven benefits for cardiovascular health and quality of life, according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement highlights that women are less likely to be referred to cardiac rehabilitation, face more barriers to participation, and have 36% lower enrollment rates compared to men, even though they experience greater mortality reductions when they do participate.
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 improvements in multiple risk factors, including higher rates of tobacco cessation, greater reductions in blood pressure and cholesterol levels, and improvements in fasting glucose levels. According to Thais Coutinho, M.D., chair of the scientific statement writing group and professor of medicine at the Mayo Clinic, "Cardiac rehab helps people recover physically after a major heart event, while also empowering patients by supporting their emotional and social well-being throughout the recovery process."
The disparities in cardiac rehabilitation access are particularly pronounced among different racial and ethnic groups. Referral rates vary dramatically, with 48% for white women, 34% for Black women, and only 15% for Hispanic women. Women entering cardiac rehabilitation programs tend to be older and have more co-existing medical conditions than men, including high blood pressure, high cholesterol, Type 2 diabetes, and obesity.
Multiple barriers affect women's ability to participate in or complete cardiac rehabilitation 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, including high copayments or transportation expenses, compared to white women.
Psychosocial factors also play a significant role in women's cardiac rehabilitation experience. Women with cardiovascular disease are more likely to experience depression, anxiety, and psychosocial distress compared to men, which can contribute to worse cardiovascular outcomes. Addressing psychosocial well-being through assessment of participants' needs and referrals to therapists or counselors when appropriate is an important component of comprehensive cardiac rehabilitation programs.
The statement also highlights 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 risk during and after treatment. There is a need to educate both cardiac rehabilitation health professionals and women with cancer and cardiovascular disease about these interconnected risks.
Some cardiac rehabilitation programs have begun addressing women's specific needs by offering broader exercise choices such as dance, yoga, or tai chi, providing greater social interaction and psychosocial support, and addressing 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 programs that include both men and women.
The scientific statement suggests several evidence-based strategies to increase referral and completion rates among women. These include increasing awareness of cardiac rehabilitation benefits, implementing automatic referral systems combined with case management to ensure all eligible women receive referrals, 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. As Coutinho emphasized, "There's an urgent need to improve awareness about the benefits of cardiac rehabilitation, increase referral rates for women and eliminate the barriers that women face so they can participate and embrace the opportunity for longer, healthier, happier lives."
