Key result
Women report similar overall CR barriers to men, peaking in the Western Pacific and Southeast Asia.
Why the study?
Cardiac rehabilitation programs are underutilized globally, especially by women, but sex differences in barriers had not been investigated across all world regions.
Do barriers to cardiac rehabilitation differ by sex across global regions?
Cross-Sectional (n=2,163)
Yes
Do barriers to cardiac rehabilitation differ by sex across global regions?
Cardiac rehabilitation barriers vary significantly by sex and region, highlighting the need for tailored mitigation strategies, particularly addressing lack of awareness and targeting unemployed women.
Women report greater CR barriers than men globally; leaves open whether targeted strategies improve enrollment and requires prospective trials.
BACKGROUND: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS: In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS: Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS: CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.
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Ghisi et al. (2023) conducted a cross-sectional in Cardiac rehabilitation indication (n=2,163). Female sex vs. Male sex was evaluated on Total cardiac rehabilitation barriers. Women did not report greater overall cardiac rehabilitation barriers than men, but reported the highest barriers in the Western Pacific (2.6/5) and South East Asian (2.5/5) regions (P<0.001).
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