Why Are Women Missing from Outpatient Cardiac Rehabilitation Programs? A Review of Multilevel Factors Affecting Referral, Enrollment, and Completion

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Abstract
Objectives: The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence women's referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future women's health research. Methods: Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-reviewed literature. Results: The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention. Conclusions: Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect women's participation.