Sex Differences in Cardiac Rehabilitation Enrollment: A Meta-Analysis.

Abstract

Background: The present systematic review and meta-analysis examines studies published in the past 10 years that described CR enrollment among women and men, in order to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men. Methods: Scopus, MEDLINE, CINAHL, PsycINFO, PubMed and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on pre-defined inclusion/exclusion criteria (guided by PRISMA) and assessed for quality using STROBE. The meta-analysis was undertaken using Review Manager software. Results: Twenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared to women (female enrollment vs male enrollment odds ratio=0.64, 95% confidence interval=0.57-0.72, p<0.00001). Heterogeneity was considered high (I2=78%). In the sub-group analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than non-systematic referral. Conclusion: Overall, rates of CR enrollment among women are significantly lower compared to men, with women being 36% less likely to enroll in a rehabilitation program.Echo: Improving Women’s Health in Ontario and Toronto Rehabilitation Institut