Women’s cardiac rehabilitation barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation’s first global assessment

Background: Cardiac rehabilitation (CR) programs are under-utilized globally, especially by women. This study investigated sex differences in CR barriers across all world regions for the first time, which characteristics were associated with greater barriers in women, and women’s greatest barriers by enrollment status.

Methods: In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale (CRBS) was administered to CRindicated patients globally via Qualtrics from October/2021 to March/2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) community facilitated participant recruitment. Mitigation strategies were provided and rated.

Results: 2163 patients from 16 countries across all six World Health Organization regions participated; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in two regions (Americas, Western Pacific) and men in one (Eastern Mediterranean; ps<.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<.001), with lack of CR awareness as the highest barrier in both. Women who were unemployed reported significantly higher barriers than those not (p<.001). Among non-enrolled 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 by region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women’s barriers in particular.