Women Face Significant Barriers in Cardiac Rehabilitation Access Despite Greater Benefits

Women experience significant disparities in accessing and participating in cardiac rehabilitation programs despite demonstrating greater mortality reduction benefits compared to men, according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement details persistent gaps in referral rates, enrollment, and completion of these evidence-based programs that have proven effectiveness in improving cardiovascular health outcomes.

Cardiac rehabilitation represents a comprehensive intervention that improves cardiovascular health through reduced hospital readmission rates, lower mortality rates, and enhanced quality of life. These programs typically include aerobic exercise and strength training, nutrition counseling, weight management, and cardiovascular disease risk factor management. Participants experience improvements in multiple 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 remain significantly underrepresented in cardiac rehabilitation programs. Research shows women are less likely to receive referrals to cardiac rehabilitation, with referral rates varying substantially across racial and ethnic groups. According to one study, referral rates stand at 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 care gap.

Women entering cardiac rehabilitation programs tend to be older and present with more co-existing medical conditions than men, including higher rates of high blood pressure, high cholesterol, Type 2 diabetes, and obesity. These clinical differences compound the challenges women face in accessing appropriate cardiac care. The scientific statement emphasizes that cardiac rehabilitation helps people recover physically after major heart events while also empowering patients by supporting their emotional and social well-being throughout the recovery process.

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 create substantial obstacles to care. Women from underrepresented racial or ethnic groups are more likely to cite cost-related barriers, such as high copayments or transportation expenses, compared to white women.

Psychosocial well-being represents another critical component of cardiac rehabilitation programs. 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. Addressing these psychological needs through assessment and appropriate referrals to therapists or counselors forms an essential part of comprehensive cardiac care.

The statement also highlights the intersection of cardiovascular disease and cancer care. Women with histories of breast or gynecologic cancers often have elevated cardiovascular disease risk, and certain cancer therapies produce adverse cardiovascular effects that increase risk during and after treatment. There exists a pressing need to educate both cardiac rehabilitation health professionals and women with cancer and cardiovascular disease about these interconnected risks.

Some cardiac rehabilitation programs designed specifically for women offer broader exercise choices including dance, yoga, or tai chi, provide greater social interaction and psychosocial support, and address insecurity concerns that women may experience regarding their appearance or physical abilities. However, evidence remains mixed regarding whether programs tailored to women's preferences prove more effective than traditional programs that include both men and women.

Increasing cardiac rehabilitation referral, participation, and completion rates among women can lead to improved cardiovascular health and quality of life for women with cardiovascular disease. Suggested solutions include raising 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. The scientific statement was prepared by a volunteer writing group on behalf of multiple American Heart Association councils and committees. Additional information about the Association's funding sources is available at https://www.heart.org.