Underrepresentation of Women in Cardiac  Rehabilitation and Referral Strategies to  Promote Enrollment: Systematic Review  and Meta-Analysis

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Research has shown that cardiac rehabilitation (CR) reduces morbidity, mortality, and unplanned hospital admissions. In addition, improvements in exercise capacity, quality of life, and mental health were reported. However, women are substantially less likely to be referred to CR and are additionally less likely to enroll when they are referred. The aim of this study was to conduct a systematic literature review about potential barriers which women face when entering CR. Underlying factors causing underrepresentation of women in CR are multifactorial and consist of individual-, healthcare provider- , and system-level factors. Individual-level factors which negatively influence enrollment rates are, for example, disease related factors and demographics, including older age. On a systemic level, for instance, a lack of health insurance financial coverage for the CR program deterred women from...Show moreCardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Research has shown that cardiac rehabilitation (CR) reduces morbidity, mortality, and unplanned hospital admissions. In addition, improvements in exercise capacity, quality of life, and mental health were reported. However, women are substantially less likely to be referred to CR and are additionally less likely to enroll when they are referred. The aim of this study was to conduct a systematic literature review about potential barriers which women face when entering CR. Underlying factors causing underrepresentation of women in CR are multifactorial and consist of individual-, healthcare provider- , and system-level factors. Individual-level factors which negatively influence enrollment rates are, for example, disease related factors and demographics, including older age. On a systemic level, for instance, a lack of health insurance financial coverage for the CR program deterred women from enrolling. One healthcare provider factor is the characteristics of CR programs, since some women were reluctant to enroll in CR due to the high intensity exercising. A meta-analysis about the effectiveness of strategies aiming to improve enrolment rates of women was performed. The risk ratio analysis did not yield clear evidence for suitable referral strategies for women to improve enrollment rates. However, two studies showed that coaching and motivational interviewing strategies can increase enrolment rates among female CVD patients. According to an event rate analysis, implementing an adequate referral strategy such as peer navigation, in combination with coaching as well as the combined peer navigation, automatic, and coaching strategy could facilitate overcoming barriers which are particularly challenging for female patients. An examination of current standards of care in each health care system or country is needed, followed by addressing the aforementioned multifactorial level barriers and the implementation of suitable referral strategies.Show less

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Underrepresentation of Women in Cardiac Rehabilitation and Referral Strategies to Promote Enrollment: Systematic Review and Meta-Analysis