Women Face Significant Barriers in Cardiac Rehabilitation Access Despite Proven Health Benefits

Women experience significant disparities in accessing and completing cardiac rehabilitation programs following major cardiac events despite proven benefits including reduced mortality rates and improved quality of life, 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 rehabilitation, face multiple barriers to participation, and have overall enrollment rates 36% lower than men.

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 experience reduced hospital readmission rates, lower mortality rates, and enhanced quality of life. Research shows women who participate in cardiac rehabilitation programs experience greater reduction in mortality compared to men, making the access disparities particularly concerning.

Referral rates to cardiac rehabilitation vary significantly among women of different racial and ethnic groups, with white women referred at 48%, Black women at 34%, and Hispanic women at just 15%. 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.

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 disproportionately impact women. Women from underrepresented racial or ethnic groups are more likely to cite cost as a barrier 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 and appropriate referrals to therapists or counselors is an important component of comprehensive cardiac rehabilitation programs.

The statement also highlights the intersection of cardiovascular disease and cancer 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 increase 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 risks.

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 whether programs tailored to women's preferences are more effective than traditional programs that include both men and women.

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 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.

The statement was prepared by a volunteer writing group representing multiple American Heart Association councils and committees. While scientific statements inform guideline development, they do not make treatment recommendations. The Association's official clinical practice recommendations are provided through its guidelines. Additional financial information about the Association is available here.