Outcomes and Cost of Women-Focused Cardiac Rehabilitation: A Systematic Review and Meta-analysis

Background: The aim of this systematic review was to investigate the effects of women-focused cardiac rehabilitation (CR) on patient outcomes and cost.

Methods: Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception-May 2020. Primary studies of any design were included, with adult females with any cardiac diseases. “Women-focused” CR comprised programs or sessions with >50% females, or 1-1 programming tailored to women’s preferences. No studies were excluded based on outcome. Two independent reviewers rated citations for potential inclusion, and 1 extracted data, including quality, which was checked independently. Random-effects meta-analysis was used where there were ≥3 trials with the same outcome; Certainty of evidence for these was determined based on GRADE. For other outcomes, SWiM was applied.

Results: 3498 unique citations were identified, of which 28 (52 papers) studies were included (3,697 participants; 11 trials). No meta-analysis could be performed for outcomes with usual care comparisons. When compared to active comparison, women-focused CR had no meaningful effect on functional capacity. Women-focused CR meaningfully improved physical (mean difference [MD]=6.37, 95% confidence interval [CI]=3.14-9.59; I2=0%; moderate-quality evidence), and mental (MD=4.66, 95% CI=0.21-9.11; I2=36%; low-quality evidence) quality of life, as well as 7/8 SF-36 domains. Qualitatively, results showed women-focused CR was associated with lower morbidity, risk factors, and greater psychosocial well-being. No effect was observed for mortality. One study reported favorable economic impact and another reduced sick days.

Conclusions: Women-focused CR is associated with clinical benefit, although there is mixed evidence and more research is needed.