Sex Differences in Cardiac Rehabilitation Adherence: A Meta-analysis

Background: Cardiac rehabilitation (CR) participation is associated with significantly lower mortality, and this benefit has been established as dose-dependent. Given it has been suggested that women adhere less than men, the objective of this study was to review cardiac rehabilitation adherence among women and men, and to determine whether a sex difference exists. Methods: MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane data bases were systematically searched. Titles and abstracts were screened, and selected full-text articles were independently considered based on predefined inclusion/exclusion criteria. Data from included articles were extracted by 2 authors independently and assessed for quality. The meta-analysis was under taken with pre-defined subgroup analyses. Results: The search identified 5148articles, of which 149were fully examined for inclusion consideration. Fourteen studies reporting data on8176participants (2,234[27.3%] women) were included. Overall, CR adherence ranged from 36.7-84.6%of sessions, with a mean of 66.5±18.2% (median=72.5%). Men and women enrolled in CR adhered to 68.6% and 64.2% of prescribed sessions, respectively(mean difference=-3.6;95% confidence interval=-6.9to-0.3). The sex difference persisted in studies of high quality, that were under taken in Canada, published since 2010, and where programs were longer than 12 weeks duration and offered less than 3 sessions per week. Conclusions: This was the first meta-analysis to systematically report CR adherence rates, suggesting patients adhere to over 2/3rds of prescribed sessions. CR adherence is significantly lower among women than men. Identified strategies to promote adherence need to be tested among women.