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Most women fail to complete cardiac rehab after acute MI
Cardiac rehabilitation has failed to reach more than 80% of eligible women in the past 3 decades, but women-tailored programs may help overcome this gap, according to a scientific statement from the American Heart Association.
“Marked reductions in CVD mortality in women have occurred for the first time this past decade, partly as a result of an increase in awareness, a greater focus on women and their [CV] risk and the application of evidence-based treatments for established CHD,” Laxmi S. Mehta, MD, FAHA, director of the women’s cardiovascular health program and an associate professor of medicine at The Ohio State University Wexner Medical Center, and colleagues wrote. “Despite these advancements, CVD remains the leading morbidity and mortality threat affecting millions of American women.”
Of the 6.6 million U.S. women affected by CHD annually, 2.7 million have a history of MI, more than 53,000 died of an MI and about 262,000 were hospitalized for ACS (acute MI or unstable angina). Acute MI disproportionately affects younger women with more than 30,000 women younger than 55 years hospitalized each year in the United States.
Cardiac rehab is an essential component of recovery after acute MI and confers incontrovertible morbidity and mortality benefits, according to studies summarized in the AHA statement. Although cardiac rehab is an important measure of health care quality, more than 80% of women who survived acute MI did not complete cardiac rehab in the past 3 decades.
Barriers to completion of cardiac rehab
Women who are uninsured, unmarried, socioeconomically disadvantaged or elderly are particularly underrepresented in cardiac rehab programs. Women with depression are two times more likely to not complete rehab, according to the statement.
Referral from their health care professional can also be a barrier to women completing cardiac rehab, although this is improving with electronic medical records, which allows people to be referred regardless of sex.
“Not having a strong social support can be a barrier for women,” Mehta told Cardiology Today. “In addition, those who have too many family obligations — such as they’re working, they have children, a spouse, and aging parents that they have to take care of — have additional barriers as well. Women tend to not put their own health first, so it feels like if they’re going to rehab, they’re taking time out for themselves and that can sometimes be a barrier to trying to convince women to do it.”
To address the gap in competition for women, Mehta said physicians should continue consistent referrals for women and to focus on addressing the common barriers.
Repetitive endorsement of cardiac rehab can show women who have had acute MI the importance.
“The physician giving that endorsement to the patient and reiterating it at their follow-up visit is key as well,” Mehta said. “So at the time of the [MI], after the [MI], the more they hear it, the greater the importance of it.”
Additionally, women who have completed rehab can be champions for the program. There are many social networks, such as blogs, that allow women to communicate after acute MI and to share the benefits of cardiac rehab. Physicians could suggest participation in these support groups in addition to their own endorsement, Mehta said.
One barrier specific to women is that they may feel uncomfortable exercising and participating in cardiac rehab around men. A solution to this, according to Mehta, is having women-only groups or sections of rehab to allow women more comfort.
Cardiac rehab programs could offer more flexible hours, particularly evenings and weekends, and even child care to address the barriers facing younger women with acute MI.
Finally, technology may provide an avenue for tackling transportation and family obligation barriers that affect women.
“Home-based [cardiac rehab] models may be an effective and realistic alternative or supplement for women with significant barriers to attending structured outpatient programs,” the researchers wrote. “Novel health care models using mobile phones, the internet and other communication technologies to deliver [cardiac rehab] services to patients in their homes could be investigated.” – by Cassie Homer
For more information:
Laxmi S. Mehta, MD, FAHA, can be reached at Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, 473 West 12th Ave., Columbus, OH 43210; email: laxmi.mehta@osumc.edu.
Disclosure: Mehta reports no relevant financial disclosures. Please see the full statement for a list of all other authors’ relevant financial disclosures.