Women and Referral to Outpatient Cardiac Rehabilitation: Does the Gender Bias Still Exist? A Meta-Analysis.

Background Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in Cardiac Rehabilitation (CR), programs which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists.

Methods

This meta-analysis was guided by PRISMA. Scopus, MEDLINE, CINAHL, PsycINFO, PubMed and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on pre-defined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE. Meta-analysis was undertaken using Review Manager software.

Results Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) were included. In the pooled analysis, women (xx%) were significantly less likely to be referred to CR compared to men (xx%; odds ratio=0.68, 95% confidence interval=0.62-0.74).

Conclusion CR referral remains too low for all patients, but is significantly lower for women. Evidence-based interventions to increase referral for all patients, including women have been identified. As recently advocated by the AHA, is time to ensure broader implementation of these strategies.