Cardiac rehabilitation: where are all the women?

Cardiac rehabilitation is a cost-effective, life-enhancing and lifesaving treatment for patients recovering from cardiac illness. However, certain patient groups are not attending these programmes, including women. While the National Service Framework set a target that 85% of eligible patients should be invited to join cardiac rehabilitation programmes, this target is far from being met—only 30% of eligible women are being invited, while attendance among men is 52%. Progress has been made in the diagnosis of myocardial infarction in women; the use of the high-sensitivity troponin I assay with gender-specific diagnostic thresholds increased the diagnosis rate in suspected cases from 11% to 22%. Despite this, women are less likely to join a cardiac rehabilitation programme than men, who are nearly twice as likely to attend. Women who are older, as well as those with greater comorbidity, higher levels of depression, lower initial exercise capacity, and less social support tended to be less likely to attend. A dislike of the exercise programme, and family obligations, can also reduce attendance. Practitioner endorsement of cardiac rehabilitation alongside advances in technology help to overcome some common barriers to women attending. More creative and dynamic ways need to be found to overcome these constraints to ensure that all those who are likely to benefit from these programmes do so.