Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and may result in better quality-of-life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary healthcare providers, a policy-maker, and patient partners. The guideline was developed in accordance with AGREE II and RIGHT. Initial recommendations were based on a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR’s audit; N=76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A webcall was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (GRADE). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing) and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but one recommendation, ≥75% voted to include; implementability ratings were <5/7 for 4 recommendations, but only one for impact. Ultimately one recommendation was excluded, one separated into two and all revised (two substantively); one recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.