It is time to rethink cardiac rehab programmes for women
Nurses can drive the changes needed, says British Heart Foundation nurse Philippa Hobson
Nurses can drive the changes needed to tackle gender inequality in this area of care, says British Heart Foundation nurse Philippa Hobson
Women are less likely than men to attend cardiac rehabilitation – that’s something we have known for years.
Prior commitments such as childcare and work-related issues, as well as feeling uncomfortable in what is seen as a predominantly male environment, have made it more likely that women will pass up on this life-saving heart aftercare.
Some women from ethnic minority backgrounds may also be deterred from attending cardiac rehab by language barriers and cultural traditions.
The British Heart Foundation’s most recent annual national audit report on cardiac rehabilitation suggests that the problem is intensifying. Only 43% of all female patients being referred for cardiac rehab in England take it up, down one percentage point from the previous year. By comparison, 54% of eligible men in England take up cardiac rehab, up 1% on the year before.
Understanding its effectiveness
Clinical guidelines ensure that cardiac rehab is offered to people who have had a heart attack, coronary angioplasty or heart surgery. It is also available to some patients who have angina or have experienced heart failure.
Programmes are designed to help patients and their loved ones understand their condition and recover from surgery. They provide advice on exercising safely for heart health and general well-being, managing risk factors, as well as other issues that may affect a patient’s recovery, such as anxiety and depression.
This care is ideally delivered by a team of specialised cardiac nurses and physiotherapists, as well as exercise specialists and clinical psychologists, but support from other healthcare professionals is also crucial.
‘The widening gap in uptake of these services is cementing the inequality in heart attack survival between men and women’
All members of the multidisciplinary team have a responsibility to be supportive and encouraging when discussing the option of cardiac rehab with their patients, regardless of gender, emphasising how effective it can be.
Research indicates that secondary prevention measures offered by a cardiac rehab programme, such as education, can reduce the risk of a patient dying from heart disease by 26%, and cut hospital admissions by around 20%.
The widening gap in uptake of these services is cementing the inequality in heart attack survival between men and women.
Not working for women
The British Heart Foundation’s figures also suggest that even if women are attending cardiac rehab, they are not reaping the same benefits as male patients. They are less likely to improve their physical fitness and meet target levels for cholesterol and alcohol intake following rehab programmes.
It is clear that cardiac rehab is not working for women. The answer to this could be rethinking the way it is delivered.
Historically, programmes offer group-based rehab in a community or hospital setting, which has been shown to be less attractive to women. At the moment, only 10% of cardiac rehab is being taken up at home. We need to cater to female patients’ busy lifestyles and provide solutions they can implement in their own homes.
The British Heart Foundation has emphasised the importance of this to the NHS in our five-point action plan Turning Back the Tide on Heart and Circulatory Diseases. We are calling on the NHS to consider expanding new models of delivery, such as digitally supported programmes, to help make cardiac rehab more appealing to female patients.
Highlight the risks
We also need to think about how cardiac rehab can be more accurately marketed and explained to patients. This means helping heart patients understand that cardiac rehab is an evidence-based treatment, and just like their medications or surgery it could be detrimental to their health if declined. By missing out on aftercare, they are increasing their risk of a further cardiac event in the future.
According to NICE guidance, as well as that of associations such as the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) and Scottish Intercollegiate Guidelines Network, cardiac rehab is clinically effective and cost-effective, and all eligible patients should take it up in a timely and appropriate manner.
If we can persuade more eligible women to take it up, the health service as well as patients will feel the benefits for years to come.
As nurses, we are in a unique position to be the driving force for change. It is vital that we close the gender inequality gap when it comes to healthcare. Rethinking the narrative around cardiac rehab, alongside the way in which we deliver services, would be a good place to start.
Philippa Hobson is a senior cardiac nurse at the British Heart Foundation