Temporal trends in the sociodemographic profile of patients enrolled in cardiovascular rehabilitation over 25 years: a retrospective cohort study

Abstract Background Exercise-based cardiovascular rehabilitation (CR) is part of the continuum of medical care and a Class I recommendation for the treatment of patients with cardiovascular diseases (CVDs), with well-established benefits in improving disease management and quality of life, and reducing morbidity and mortality. However, global enrollment remains low (~20%-50%). Barriers such as age, sex, and other social determinants of health continue to limit participation. Objective To assess the temporal trends in the sociodemographic profile of patients enrolled in CR between 2001 and 2025. Methods This observational, retrospective cohort study analyzed sociodemographic data from patients with CVD who enrolled in a CR program at Canada's largest cardiovascular health centre between 2001 and 2025. Several programs are offered to approximately 4,000 patients annually. All data were extracted in anonymized digital batches from three separate databases (2001-2015; 2015-2020; 2020-2025), systematically cleaned, and harmonized. Participants were grouped into 5-year intervals according to their enrollment date. Age groups were categorized as ≤44, 45-64, and ≥65 years old. One-way ANOVA, with Bonferroni post-hoc tests, was used to compare changes in measures over time. Chi-square analyses, with post-hoc tests, were used to compare the proportion of sociodemographic categories across timepoints and gender within each age group. Age is presented as median (interquartile range). Age and gender were available between 2001 and 2025, whereas education, occupational status, marital status, and ethnicity were only available between 2001 and 2020. The CR program between 2001 and 2005 comprised a single case-managed home program, but later expanded to include several in-person, hybrid, and remote program offerings. Results The study included 40,822 participants (meanSD age, 64 17 years; 30.7% women; 59.5% with coronary artery disease). Over the past two decades, the sociodemographic diversity of enrolled patients in CR has significantly increased (p0.001 for all). The median age rose from 58±18 years (2001-2005) to 67±17 years (2021-2025). Women participation decreased from 38.6% (2001-2005) to 27.8% (2006-2010) but then increased to 33.4% (2021-2025). Across all age groups, women participation varied significantly (p0.001). The proportion of patients with primary or incomplete secondary education increased from 14.4% (2001-2005) to 20.6% (2016-2020). Approximately half of patients were employed (50.2%), and 74.2% of patients were married or in common-law relationships. Ethnicity diversity also shifted, with non-white patients increasing from 9.4% (2006-2010) to 14.9% (2016-2020). Conclusion Increasing diversity among CR participants reflects progress towards more equitable population-wide opportunities for cardiovascular secondary prevention. However, ongoing advocacy remains necessary to further expand access to CR in Canada and across the globe.