Bridging the Gender Gap in Cardiac Rehabilitation

Cardiovascular disease remains the leading cause of death among women worldwide, accounting for approximately one in three female deaths.¹ Despite advances in prevention and treatment, women continue to be underrepresented in cardiac rehabilitation programs following myocardial infarction, coronary revascularization, or heart failure hospitalization.² What strategies are effective in bridging the gender gap in cardiac rehabilitation?

Benefits of Cardiac Rehabilitation

Cardiac rehabilitation, or cardiac rehab, is a comprehensive, evidence-based intervention that includes supervised exercise training, cardiovascular risk reduction, education, and psychosocial support. Participation in cardiac rehab reduces cardiovascular mortality by approximately 20–30% and significantly improves modifiable risk factors such as hypertension, dyslipidemia, obesity, and physical inactivity.²

Women and Cardiac Rehabilitation: Benefits and Challenges

Women who complete cardiac rehab have survival benefits comparable to—and in some cases greater than—those observed in men.² Despite the proven benefits, women are less likely than men to be referred to cardiac rehab programs, and even when referrals occur, enrollment rates remain significantly lower for women.^{3, 4}

Research shows that women are 20–30% less likely to be referred to cardiac rehab compared with men, and even after referral, they are less likely to attend or complete programs.^3,4 This disparity is observed across geographic regions and healthcare systems, with older women and those from racial and ethnic minority groups displaying particularly low participation rates.³

Compared to their male counterparts, women entering cardiac rehab tend to be older and present with a greater number of comorbidities, such as hypertension, diabetes, and obesity, which may complicate both referral decisions and program adherence.^3,4 Structural contributors to these disparities include provider referral bias, delayed diagnosis or atypical symptoms in women, and competing life responsibilities such as caregiving and financial constraints. ^3,4 Women from underrepresented racial and ethnic groups face additional barriers, including lower likelihood of receiving clinician recommendations and greater socioeconomic obstacles.⁵

Beyond referral disparities, women encounter other barriers that interfere with cardiac rehab participation. Caregiving responsibilities, transportation challenges, employment demands, and financial concerns frequently limit attendance. Women also report higher levels of anxiety and depression following cardiac events, which may reduce adherence and completion rates.⁴

Facility- and Home-based Cardiac Rehabilitation

Traditional center-based cardiac rehab programs—often structured around fixed schedules and facility-based exercise—may not adequately accommodate women’s needs. Emerging models of cardiac rehab delivery show promise in addressing gender-specific barriers. Home-based cardiac rehab has been shown to produce outcomes comparable to those of traditional center-based programs while offering greater flexibility and accessibility.⁶ These programs incorporate remote monitoring, individualized exercise prescriptions, and structured follow-up, allowing participants to engage in rehabilitation without the burden of frequent travel. For those balancing family and professional responsibilities, home-based cardiac rehab may significantly improve enrollment and adherence.

Improving Access to Cardiac Rehabilitation

To reduce disparities, experts recommend implementing automatic referral systems prior to hospital discharge to ensure all eligible patients are offered cardiac rehab services.² Enhancing care coordination, reducing financial barriers, and incorporating hybrid delivery models that combine in-person and virtual components may further expand access.⁶ Addressing both structural and psychosocial barriers is essential to improving participation rates among women.

The Role of Nurses in Promoting Cardiac Rehabilitation

• Cardiovascular hospital nurses play a critical role in promoting cardiac rehabilitation by identifying eligible patients, providing education about the benefits of participation, and facilitating referral prior to discharge.⁷
• Nurses can assess patients’ readiness, address misconceptions, and help overcome barriers to participation.
• By coordinating with multidisciplinary teams, including cardiologists, exercise specialists, and cardiac rehab program staff, nurses can ensure smooth transitions from inpatient care to outpatient rehabilitation.
• Additionally, ongoing follow-up by nurses can reinforce adherence to exercise, lifestyle modification, and medication regimens, improving enrollment, completion rates, and long-term cardiovascular outcomes.⁷
• Utilizing clinical resources such as those available at pcna.net can assist patients and their families navigate the recovery process and support improved patient outcomes.

Cardiac rehabilitation is a life-saving intervention that remains underutilized among women despite well-documented benefits. Ensuring women have full access to cardiac rehab services is essential to reducing preventable morbidity and mortality from cardiovascular disease. Expanding home-based options, implementing universal referral protocols, and developing women-centered programming are critical strategies for advancing equity in cardiovascular secondary prevention.