Cardiac Rehabilitation in Women: A Scientific Statement From the American Heart Association

Cardiac rehabilitation (CR) is a proven intervention to improve cardiovascular health, offering benefits such as reduced hospital readmission rates, lower mortality rates, and enhanced quality of life. Poor CR participation, which is a universal problem, is particularly pronounced in women. Considerable sex and gender disparities exist in CR access, engagement, and outcomes. Despite the effectiveness of CR, women are underrepresented in CR programs, and face barriers related to lower referral rates, medical comorbidities, societal roles, and financial constraints. These challenges are further compounded by racial and ethnic disparities. Women also have greater needs for specific aspects of CR, including mental health support and social integration. Traditional CR programs often fail to address these needs adequately, contributing to proportionally lower participation and completion rates among eligible women. Further research is needed to assess the efficacy of CR programs in women, including women from underrepresented racial or ethnic groups, and to identify optimal CR approaches in specific populations, such as people with spontaneous coronary artery dissection, ischemia, myocardial infarction with nonobstructive coronary arteries, or stress-induced cardiomyopathy. To optimize CR participation and outcomes in women, a multifaceted approach is required. Strategies such as automatic referral systems, gender-sensitive program design, and mental health integration are essential. Further research is needed to determine the impact of nontraditional delivery models on women's cardiovascular health. Addressing these gaps can lead to improved cardiovascular health and quality of life for women with cardiovascular disease.