Key result
Female sex was not significantly associated with differences in cardiac rehabilitation participation compared to male sex among eligible U.S. Veterans (adjusted OR 0.90), with overall participation remaining low at 10.4%.
Why the study?
Does female sex or socioeconomic deprivation reduce cardiac rehabilitation participation in U.S. Veterans eligible for secondary prevention?
Cohort (n=82,496)
Yes
Does female sex or socioeconomic deprivation reduce cardiac rehabilitation participation in U.S. Veterans eligible for secondary prevention?
Cardiac rehabilitation participation among U.S. Veterans is critically low at 10.4%, with no significant sex differences but a marked reduction in uptake among those with high socioeconomic deprivation.
Answers are grounded in this paper and cite their sources.
Low CR participation persists in veterans without sex differences; leaves open socioeconomic barriers for prospective study before practice change.
BACKGROUND: Veterans are at an increased cardiovascular risk compared to age- and sex-matched non-Veterans. Cardiac rehabilitation (CR) can improve outcomes in cardiovascular disease, but its use in men and women Veterans is not well understood. OBJECTIVES: This study aimed to examine CR participation by sex and socioeconomic status among Veterans. METHODS: The authors conducted a retrospective cohort study from January 1, 2021, to December 31, 2023, using a national electronic health record database. The primary outcome was participation in at least 1 CR session among patients within 1 year of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery. Multivariable logistic regression models accounted for patient-level (demographics, medical/psychiatric comorbidities) and community-level factors. Area deprivation indices (ADIs) (analyzed as quartiles) assessed socioeconomic status. RESULTS: Among 82,496 CR-eligible Veterans (3.6% women), CR participation was low (10.4%) and similar by sex (women = 10.2%, men = 10.4%). Women Veterans did not differ significantly in CR participation compared to men Veterans after adjusting for patient-level and community-level characteristics, including age, race, cardiac and comorbidities, mental health risk factors, rural-urban status, and ADI (adjusted OR: 0.90; 95% CI: 0.79-1.03; P = 0.121). Veterans in the most deprived ADI quartile were less likely to participate vs the least deprived quartile (adjusted OR: 0.82; 95% CI: 0.75-0.89; P < 0.001). CONCLUSIONS: CR participation among U.S. Veterans remains low, far below that of the Medicare population (10.4% vs 28%), with no significant differences in initiation by sex. However, low socioeconomic status is associated with decreased uptake. Further research is needed to explore innovative, Veteran-specific CR delivery models.
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Varghese et al. (2026) conducted a cohort in Cardiovascular disease (Myocardial infarction, PCI, or CABG) (n=82,496). Female sex vs. Male sex was evaluated on Participation in at least 1 cardiac rehabilitation session within 1 year of qualifying event (adjusted OR 0.90, 95% CI 0.79-1.03, p=0.121). Female sex was not significantly associated with differences in cardiac rehabilitation participation compared to male sex among eligible U.S. Veterans (adjusted OR 0.90), with overall participation remaining low at 10.4%.
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