A panel of experts from International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) has noted that women are less likely to attend a cardiac rehabilitation programme and will experience worse outcomes than men. The panel was convened recently to develop new clinical practice guidelines for cardiac rehabilitation programmes.
The new guidelines were endorsed by 24 clinical societies worldwide, each providing guidance on how to create a more effective, women-focused, cardiac rehabilitation programme. The guideline appears in the Canadian Journal of Cardiology.
“It has long been established that women are significantly less likely to access and complete a cardiac rehabilitation programme and that their outcomes are often poorer, despite greater need than men,” explained lead author Sherry L. Grace, PhD, from the Faculty of Health at York University.
The new ICCPR clinical practice guideline provides guidance on how to design better cardiac rehabilitation programmes for women with cardiovascular disease, including peripheral artery disease and stroke. The new guidelines will aim to increase engagement and optimise outcomes for women around death, hospitalisation, function, well-being, psychology, and quality of life. Additionally, the ICCPR provides advice on the cost and resource implications of a new cardiac rehabilitation programme.
The ICCPR identified women-focused researchers who had previously worked on a cardiac rehabilitation programme. These researchers formed a writing and consensus panel that included experts from diverse geographic backgrounds and were made up of multidisciplinary healthcare providers, a policymaker, and patient partners. These individuals drafted and reviewed the recommendations.
The draft was then reviewed externally by the 24 cardiac clinical societies before being posted online for public feedback. The guidelines present 15 recommendations relating to referral, setting, and delivery. When compiled these recommendations, and the associated tools can provide support as part of any women-focused cardiac rehabilitation programme.
Some of the key recommendations are:
- All women should be systematically referred to their women-only virtual education or exercise sessions or peer support programmes to avoid bias
- When developing a woman’s tailored cardiac rehabilitation programme plan, full consideration should be given to their full clinical histories, such as any mental health and psychosocial issues, menopausal status, frailty, and cancer history
- Any new women-only virtual education or exercise sessions or peer support programmes should offer women-focused programming, comprising as many of the definitional elements of women-focused cardiac rehabilitation as possible. Where resources are limited, this should include offering women-only virtual education or exercise sessions, or peer support programmes
- Women should be given a choice in where they participate in their cardiac rehabilitation programme. Whether this is home-based or centre-based they should be delivered in a women-friendly environment and their needs and preferences should be taken into consideration when forming their cardiac rehabilitation programme
- Programmes should include a strong psychosocial component, a choice of exercise modalities, and specific education on women and cardiovascular disease.
“For the first time, there are a consensus definition and recommendations for women-focused CR, so it is hoped now that many programmes will incorporate these elements into their programmes,” said Professor Grace. “If implemented, more women may engage in CR, and as a result have significantly greater quality and quantity of life.”
Cardiovascular disease is the leading cause of death among women globally, with 6,400 cases per 100,000 women. While the global burden of cardiovascular disease has declined since 1990, it has increased in many African, Asian, and western pacific countries.
“The ICCPR acknowledges that across the globe women have experienced worse outcomes from CVD and worse uptake to prevention and rehabilitation programmes,” commented Robyn Gallagher, professor at Sydney Nursing School, Faculty of Medicine and Health, at the University of Sydney and ICCPR chair. “The Women-Focused Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline provides recommendations that will help clinicians and health service designers to develop and deliver programmes that address this inequity for women, regardless of resource contexts.”
Reference
Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline.
https://doi.org/10.1016/j.cjca.2022.06.021
