BACKGROUND: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS: In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS: Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS: CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.

Chengdu Wanda UPMC Hospital Chengdu China

Department of Cardiac Rehabilitation Cecina Hospital Cecina Italy

Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Taipei Taiwan

Department of Physiotherapy Faculty of Health Sciences University of Thessaly Thessaly Greece

Department of Rehabilitation University Hospital Brno Brno Czech Repub

Graduate Program in Rehabilitation Sciences Department of Physical Therapy Federal University of Minas Gerais Belo Horizonte Minas Gerais Brazil

Institute for Cardiovascular Diseases Dedinje and Belgrade University Faculty of Medicine Belgrade Serbia

KITE Toronto Rehabilitation Institute University Health Network University of Toronto Toronto Ontario Canada

KITE Toronto Rehabilitation Institute University Health Network University of Toronto Toronto Ontario Canada; Faculty of Health York University Toronto Ontario Canada

Laboratory of Sports Medicine Department of Physical Education and Sports Science Thessaloniki Greece

Physiotherapy School and Centre Seth G S Medical College and KEMH Parel Mumbai India

Rehabilitation Clinic Mons G Calaciura Biancavilla Catania Italy; Gibiino Cardiovascular Diagnostic Center Catania Italy

Rehabilitation Department King Abdullah Medical City Makkah Saudi Arabia

São Paulo State University School of Technology and Sciences Presidente Prudente Brazil

Seoul National University Bundang Hospital Seongnam si South Korea

Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China

Susan Wakil School of Nursing and Midwifery Faculty of Medicine and Health University of Sydney Camperdown Australia

TSMU Sports Medicine and Rehabilitation Clinical Centre Cardiac Rehabilitation Tbilisi Georgia

Yazd Cardiovascular Research Center Non Communicable Diseases Research Institute Shahid Sadoughi University of Medical Sciences Yazd Iran

References provided by Crossref.org

Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs