Women and Cardiovascular Rehabilitation Programs

Julie S. MacMillan, RN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2001;1(3) 

Introduction

Cardiovascular disease (CVD) is the primary cause of death among women in the United States, accounting for 512,904 deaths in 1999.[1] This figure represents 53.5% of female deaths in the year 1999.[1] Unfortunately, CVD is still viewed as a male disease and the participation rates of women in cardiovascular rehabilitation programs reflects this perception. Ades and colleagues[2] reported that only 15% of eligible women entered outpatient rehabilitation programs compared with 25% of eligible men. Another study found that only 25% of the women discharged with myocardial infarction or angina were referred and subsequently attended a rehabilitation program.[3] Given the high occurrence of heart disease in women, it is surprising that there are such low numbers of women in cardiovascular rehabilitation programs.

Many healthcare providers are familiar with the benefits of cardiovascular rehabilitation for patients after myocardial infarction, angioplasty, intracoronary stent placement, coronary artery bypass surgery, and those with stable angina. Nonetheless, many primary care providers do not encourage participation and refer cardiovascular patients, especially women, to cardiovascular rehabilitation.[2] Although there are many factors that influence a patient's participation in a rehabilitation program, the most powerful predictor of participation has been shown to be the strength of the primary care physician's recommendation.[4] Nurse practitioners are increasingly in the role of a primary care provider, and it is the responsibility of primary care nurse practitioners to refer all patients, especially female, to rehabilitation programs.

The outcomes for women who complete cardiovascular rehabilitation programs are considerable and have been shown to be similar to those of men.[4,5] In one study, women improved their exercise tolerance by 30% after 3 months of rehabilitation, whereas men increased their exercise tolerance by 16%.[5] In another study of older participants (> 62), women improved peak aerobic capacity by 17%, as compared with 19% for men after a 12-week program.[4] As shown by these data, women demonstrate great improvements in exercise tolerance and conditioning by participating in rehabilitation programs. Cannistra and colleagues[5] suggested that there may be a greater benefit for women since they typically begin exercise programs with a lower functional capacity.

Primary care providers must refer women patients to cardiovascular rehabilitation programs in order for female cardiac patients to realize the demonstrated benefits of rehabilitation. The lack of referral for women who have CVD by primary healthcare providers continues to contribute to low participation of women in cardiovascular rehabilitation programs. Nurse practitioners caring for women with heart disease must take an active role in referring patients to cardiovascular rehabilitation programs.

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