Inequities Across the Cardiac Rehabilitation Care Pathway in Ontario: A Preliminary Evidence Review

Background: Cardiac rehabilitation (CR) is an essential component of cardiovascular secondary prevention. However, disparities in referral, enrollment, attendance, and program completion continue to affect equitable access to rehabilitation services. Objective: This preliminary evidence review examines published research concerning inequities across the cardiac rehabilitation care pathway in Ontario, Canada, with particular attention to demographic, socioeconomic, geographic, and clinical determinants. Methods: Published Ontario research was identified through preliminary searches of PubMed, Europe PMC, and OpenAlex. A working inventory of 276 unique candidate records was assembled. Findings presented here are drawn from a selected interim subset of studies. Comprehensive eligibility screening and independent verification have not yet been completed. Findings: Ontario research indicates that inequities occur at multiple stages of cardiac rehabilitation. In one cohort of 3,739 patients eligible following cardiac revascularization, 51.8% received a rehabilitation referral. Other Ontario studies identified lower referral and enrollment among women, socioeconomic barriers affecting participation, and reduced session attendance associated with geographic barriers. Depression was also associated with increased noncompletion and nonadherence among rehabilitation participants. Conclusion: Available evidence suggests that inequalities in cardiac rehabilitation access and utilization are stage-specific. Improving equitable cardiovascular care requires attention to referral practices, socioeconomic circumstances, geographic accessibility, psychosocial factors, and continuity of participation. This manuscript is an independently authored preliminary evidence review (Version 1.0, November 2026). It has not undergone peer review and does not represent a completed systematic or scoping review.