Women are less likely than men to participate fully in cardiac rehabilitation programs, which could impede their recovery from heart attacks and heart procedures, say Canadian researchers.
“It is very important for physicians to refer men and women to cardiac rehab,” senior author Dr. Sherry L. Grace from York University in Toronto told Reuters Health. “It is the first, necessary step for patients to gain access to this mortality-reducing model of care,” she said by email.
Participation in cardiac rehabilitation is associated with improved survival, functional status and psychological wellbeing, as well as lowered risk of recurrent cardiac events. But previous studies have shown that women are significantly less likely than men to take advantage of cardiac rehabilitation, the study team writes in the Canadian Journal of Cardiology.
They analyzed data from 14 published studies to see how many people participated in prescribed cardiac rehabilitation and how many stuck with it through the end. The combined studies included a total of 8,176 men and women.
Cardiac rehabilitation programs in these studies ranged in duration from 8 weeks to 32 weeks. Overall, patients went to 66.5 percent of prescribed sessions. Looking at men and women separately, however, the researchers found that men went to nearly 69 percent of sessions while women went to just 64 percent, on average.
The gender gap was especially apparent for programs of 12 weeks duration or more, after which women’s participation dropped off. The divergence between men and women also seemed to appear only in studies after 2009, the study authors note, although they can't say why.
“Overall, patients adhered to two-thirds of prescribed sessions," Grace said. “People often contend that cardiac rehabilitation should not be funded because patients only attend half of sessions. Clearly this is not the case. They certainly adhere quite well.”
As for reducing the disparity between men and women, Grace suggested that "offering women-only classes, tailored to women’s needs and preferences, may help; however, there is mixed evidence.”
"It is well known that women are referred less, and therefore enroll less, in cardiac rehabilitation, but it was surprising to see that even if they enroll their adherence is less than that of men,” said Dr. Karin H. Humphries from University of British Columbia in Vancouver, who co-authored a related editorial.
“A roughly 4 percent difference in adherence may seem trivial, but cardiac rehabilitation programs are designed to optimize outcomes so an adherence rate of only 64 percent is worrisome,” Humphries told Reuters Health by email.
“While not directly addressed by this paper, encouraging women to participate in cardiac rehabilitation is still important," she said. “And emphasizing the importance of adherence is also important. So discussions about finding child support, if relevant, or transportation solutions to help them attend, could help.”
Dr. Diann Gaalema from the University of Vermont's Center on Behavior and Health in Burlington recently found in a separate study that financial incentives could help increase cardiac rehabilitation participation and adherence among Medicaid patients.
"Something in the system is not optimized for female patients. Cardiac rehabilitation did start as a male-only model decades ago, and it's possible that the system has not evolved along with the changes in referral practices,” she said in an email.
“Really there are many reasons people drop out of cardiac rehabilitation,” Gaalema said, including time, transportation and other medical conditions, both physical and psychological, “and your best bet may be to carefully screen people coming in to see what their particular challenges are and try to adjust accordingly."
