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Experts say cardiovascular rehab programs are under-utilized by women. Luis Alvarez/Getty Images
  • Heart disease is the leading cause of death for women in the United States .
  • Cardiovascular rehabilitation programs can reduce rates of death and re-hospitalization.
  • Experts say women are underrepresented in these programs and are not reaping the important health benefits.
  • Family responsibilities, program costs, and access are some of the factors that are preventing women from attending.

Women are not reaping the benefits of cardiovascular rehabilitation programs at the same rate as men.

According to a study published on September 24 in The Canadian Journal of Cardiology, women face many barriers to attending programs that can significantly reduce death and re-hospitalization rates.

Sherry Grace, PhD, the lead investigator of the study and the director of Research of Cardiac Rehabilitation at the Peter Munk Cardiac Centre at York University in Toronto, said in a press statement:

“The benefits of cardiac rehab participation are remarkable, plus patients get back their vitality and can return to their meaningful life roles. Unfortunately, women face many structural barriers to attending – from the individual to health system levels. We developed the Cardiac Rehab Barriers Scale (CRBS) almost 25 years ago to better characterize them, and it remains the most widely used and rigorous measurement scale to assess these barriers.”

Cardiovascular rehabilitation programs, also known as cardiac rehab, are programs designed to improve the cardiovascular health of those who have experience heart failure, heart attack, heart surgery, or angioplasty.

The programs are medically supervised and involve exercise, counseling for stress reduction, and education to promote heart-healthy living.

Cardiovascular rehabilitation programs are known to improve health outcomes, but experts say they are underutilized by women.

“Cardiac rehab has been shown to be the single most beneficial intervention after someone has developed symptomatic heart disease. Above medications and procedural interventions,” Dr. Shannon Hoos-Thompson, a cardiologist at The University of Kansas Health System who was not involved in the new study, told Medical News Today.

“Heart rate, blood pressure, heart rhythm, and symptoms are monitored, and the exercise program is adapted by a protocol to each individual patient at various levels from enrolment. Basically heart disease patients are trained to take care of their cardiovascular health and learn the importance of making time for their heart health,” she added.

The new study is the first of its kind to examine the barriers faced by both men and women in accessing rehabilitation programs.

In this research, 2,000 people in 16 countries were given an online survey. The participants were either cardiac inpatients who were eligible to undergo cardiovascular rehabilitation programs or patients who were just beginning their rehabilitation program.

All six World Health Organization regions were represented. This included Africa, the Americas, South East Asia, Europe, the Eastern Mediterranean, and the Western Pacific.

The researchers found that both men and women face major barriers to utilizing cardiovascular rehabilitation. Female patients have a greater burden of barriers in the Americas than men. The greatest burden for women was found in the Western Pacific and South East Asia.

Researchers reported that women who were unemployed experienced greater barriers than women who were employed.

The barriers faced by women who were not yet enrolled in a cardiovascular rehabilitation program included not knowing the programs existed, programs failing to contact women after referral, program cost, and finding exercise painful or tiring.

Barriers to adherence to a program for enrolled women include family responsibilities, travel, distance to facilities, and transportation difficulties.

“Women’s cardiovascular disease doesn’t always get the attention that it deserves. Women often think of themselves last, they’re caregivers for others,” Dr. Helga Van Herle, a cardiologist with Keck Medicine of USC in California who was not involved in the study, told Medical News Today.

“It’s just sort of the trend that we see in women’s heart health, that we really have to be strong for ourselves and look out for ourselves,” she added. “And it is not the wrong thing to do to ask your physician about cardiac rehab, especially if you are in a category that will benefit.”

As part of the study, participants were provided with potential mitigation strategies to help overcome barriers to attending. These included doing home-based programs or having discussions with healthcare providers.

More than 70% of women rated the information as helpful or very helpful.

Van Herle said it is important that women communicate with their healthcare provider about any challenges they may face attending or adhering to a rehabilitation program.

“It’s a conversation that the patient and their physician need to have. If things are painful, if exercise is painful there are modifications can be made, but you need to be in contact with the programme. They’re usually run by exercise physiologists, who are also physical therapists so there’s ways to address some of these things,” she said.

Typically, cardiovascular rehabilitation programs run for three months but may range from two to eight months.

People who attend 36 sessions have a 47% lower risk of death as well as a 31% lower risk of heart attack compared with those who only attend one session.

Heart disease is the leading cause of death for women in the United States, but women are still under-referred to cardiac rehabilitation programs. Black women are 60% less likely than white women to be referred to or enroll in a program.

Hoos-Thompson says this is an example of a broader problem in the management of female cardiovascular health.

“Heart disease continues to be an under-appreciated disease in women. We overlook women at risk, under-treat women that present with unstable heart conditions and don’t address the ongoing dysfunction after heart events. This is a social and cultural problem that is evident in healthcare,” she explained.

Cardiovascular rehabilitation programs can reduce death from all causes by 15% at one-year follow-up and by 45% at 15 years follow-up. It can also lower mortality rates from cardiovascular disease by 30%.

Experts say that better female attendance in such programs could make a big difference to the health outcomes of women around the world.

“Knowing that currently 60 million women live with heart disease and more than 300,000 women die annually in the USA that is a whole lot of impact waiting to happen. Now apply that worldwide,” Hoos-Thompson said.