Women may participate less often than men in cardiac rehabilitation programs, despite substantial benefits for survival, readmission, and quality of life, according to a new Scientific Statement from the American Heart Association.
Across studies, participation in cardiac rehabilitation was about one-third lower among women compared with among men. Enrollment among eligible women was roughly 36% lower, and participation among non-Hispanic Black, Hispanic, and Asian women averaged 10% to 12%. However, women who completed cardiac rehabilitation programs experienced similar or greater improvements in outcomes compared with men. In a cohort of about 400,000 adults, 300 minutes of weekly aerobic activity reduced all-cause mortality by 24% in women compared with 18% in men, whereas three weekly resistance training sessions reduced all-cause mortality by 28% in women vs 14% in men.
Cardiac rehabilitation improved exercise capacity, reduced depressive symptoms, and supported medication adherence. However, women faced persistent barriers in accessing care, including caregiving duties, comorbidities, transportation challenges, and lower referral rates. Automatic referral systems were associated with large gains in access—up to a 25-fold increase when combined with case management and more than 10-fold with automated referrals alone.
The Scientific Statement summarized data from observational studies, randomized controlled trials, and meta-analyses examining sex-specific participation and outcomes. Investigators reviewed interventions such as electronic referrals, behavioral support, and hybrid or home-based models. Conditions evaluated included coronary heart disease, heart failure, spontaneous coronary artery dissection, ischemia with nonobstructive coronary arteries, stress-induced cardiomyopathy, and cardio-oncology cases.
Women remained underrepresented in cardiac rehabilitation research. Sex-specific data were limited, and safety evidence was insufficient for certain diagnoses predominantly affecting women. The American Heart Association (AHA) noted that financial strain and caregiving roles weren't consistently measured across studies, reducing generalizability.
The AHA emphasized that closing participation gaps requires system-level strategies, including automatic referrals with case management and program designs responsive to women’s responsibilities. The organization called for integrating psychosocial and peer-support components, expanding hybrid and home-based options, and ensuring cultural and logistical accessibility.
“Implementation of these strategies can facilitate access to [cardiac rehabilitation] programs for women, promoting their quality of life and long-term cardiovascular health,” said lead study author Thais Coutinho, MD, Chair of the Scientific Statement and Head of the Division of Cardiac Prevention and Rehabilitation at the University of Ottawa Heart Institute, and colleagues.
Future research should include sufficient numbers of women and evaluate exercise responses by sex. The AHA also recommended testing new rehabilitation models and addressing psychosocial needs unique to women with cardiovascular disease. The Scientific Statement concluded that advancing equity in cardiac rehabilitation may depend on intentional inclusion of women in both research and program design. Implementing these strategies could improve access, outcomes, and long-term cardiovascular recovery among women worldwide.
The authors reported no conflicts of interests.
Source: AHA Journals
