Cardiovascular diseases are the primary cause of mortality among women in the United States. Despite the availability of cardiovascular rehabilitation programs, which have been proven to reduce mortality and re-hospitalization rates, women are significantly underrepresented in these programs. A recent study published in The Canadian Journal of Cardiology has shed light on the multifaceted barriers that prevent women from benefiting from these programs.
The study, led by Sherry Grace, PhD, Director of Research of Cardiac Rehabilitation at the Peter Munk Cardiac Centre at York University in Toronto, utilized the Cardiac Rehab Barriers Scale (CRBS) to assess the barriers faced by women. The CRBS has been in use for nearly 25 years and remains the most rigorous measurement scale for this purpose. The study is groundbreaking as it is the first to examine the barriers faced by both men and women in accessing cardiovascular rehabilitation programs.
The research involved an online survey of 2,000 individuals from 16 countries, representing all six World Health Organization regions. The participants were either cardiac inpatients eligible for cardiovascular rehabilitation or those who had just commenced their rehabilitation programs.
The study revealed that women face a greater burden of barriers compared to men, particularly in the Americas, Western Pacific, and South East Asia. Unemployed women experienced more barriers than their employed counterparts. The primary obstacles for women not yet enrolled in a program included lack of awareness, failure of programs to contact them post-referral, prohibitive costs, and physical discomfort during exercise. For those already enrolled, the barriers were family responsibilities, travel constraints, distance to facilities, and transportation issues.
Expert Opinions
Dr. Shannon Hoos-Thompson, a cardiologist at The University of Kansas Health System, emphasized that cardiac rehab is the most beneficial intervention for symptomatic heart disease, surpassing medications and procedural interventions. Dr. Helga Van Herle, a cardiologist with Keck Medicine of USC in California, pointed out that women often prioritize caregiving roles over their health, which contributes to the underutilization of cardiac rehab programs.
The study also provided potential solutions to overcome these barriers, such as home-based programs and consultations with healthcare providers. Over 70% of women found this information helpful. Dr. Van Herle stressed the importance of open communication between patients and healthcare providers to address challenges in attending or adhering to a program.
Typically, cardiovascular rehabilitation programs last for three months but can range from two to eight months. Attendance of 36 sessions can reduce the risk of death by 47% and the risk of heart attack by 31%.
The study highlights a systemic issue in the management of female cardiovascular health. Black women are 60% less likely to be referred to or enroll in a program, indicating racial disparities as well. Dr. Hoos-Thompson stated that this is a reflection of a broader social and cultural problem evident in healthcare.
The underrepresentation of women in cardiovascular rehabilitation programs is a critical issue that requires immediate attention. The study provides valuable insights into the barriers faced by women and offers potential solutions. Addressing these barriers could significantly improve the health outcomes for millions of women globally.
