Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Abstract

Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.

Sex Differences in Ischemic Heart Disease

“…53,54,73 Sex-based attrition occurs at each step of cardiac rehabilitation: referral, enrollment, and adherence (Table 1). Potential barriers for suboptimal enrollment of women in cardiac rehabilitation included inadequate reinforcement by healthcare professionals, financial constraints, inadequate patient awareness, perception of exercise being painful, suboptimal social support system, transportation issues, family responsibilities, and higher comorbidities.…”

“…Alternate modes of delivery such as telemedicine or web-based approaches that offer flexible hours and personalized treatment options may be better embraced by women. 73 Other gendered determinants of health, including access to education and economic opportunities, access to community resources and healthcare, social support, language and literacy, significantly contribute to differences in delivery of care for women, particularly racial and ethnic minorities. 15 These often overlooked factors expose patients to unique risks, may restrict access to care, and make them vulnerable to worse outcomes.…”

The role of cardiovascular rehabilitation in women with ischemic heart disease and rhythm disorders

“…At the same time, unfortunately, they receive less support from their partner, thus focusing on the support of their children. For the elderly female patients, we emphasize that most are alone, only 26-59% have a life partner, compared to male patients where the percentage is 70-91% [6,7,8,14,16].…”

“…It also increased the quality of life, significantly reduced anxiety and depression, as well as improving education and information on the disease and the importance of the recovery. These beneficial results are also obtained in the case of coronary microvascular disease, the most common form of ischemic cardiopathy experienced in women [16].…”

“…At the same time, women get bored faster if they do the same kind of physical training, they adjust much harder and tend to underestimate their effort capacity [14,16].…”