Women face substantial barriers in accessing and completing cardiac rehabilitation programs despite evidence showing they experience greater mortality benefits than men, according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement details significant disparities in cardiac rehabilitation access, participation, and outcomes between women and men with cardiovascular disease. Cardiac rehabilitation is a proven intervention that improves cardiovascular health through programs typically including aerobic exercise, strength training, nutrition counseling, weight management, and cardiovascular disease risk factor management. People who participate in these programs experience improved quality of life, reduced hospital readmission rates, lower mortality rates, and better management of cardiovascular risk factors including higher rates of tobacco cessation, greater reductions in blood pressure and cholesterol levels, and improvements in fasting glucose levels.
Despite these proven benefits, women are significantly underrepresented in cardiac rehabilitation programs. Women are less likely to be referred to cardiac rehab, with referral rates varying dramatically among different racial and ethnic groups: 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 substantial healthcare disparity. 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, including caregiving responsibilities, transportation challenges, scheduling conflicts, financial constraints, and limited social support. Women from underrepresented racial or ethnic groups are more likely to cite cost as a barrier compared to white women.
Addressing psychosocial well-being is particularly important for women in cardiac rehabilitation. 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. The statement also highlights that women with a history of breast or gynecologic cancers often have elevated cardiovascular disease risk, and certain cancer therapies have adverse cardiovascular effects that increase risk during and after treatment. Some cardiac rehabilitation programs designed specifically for women include broader exercise choices such as dance, yoga, or tai chi, provide greater social interaction and psychosocial support, and address insecurity concerns women may have about their appearance or physical abilities. However, evidence remains mixed about whether programs tailored 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 life-saving programs could significantly enhance cardiovascular health and quality of life for women with cardiovascular disease.
