The Representation of Women and Racial Minorities in Cardiac Rehabilitation: An Integrative Literature Review of Referral, Enrollment, and Adherence

Cardiac rehabilitation (CR) is an evidence-based intervention that assists individuals in managing a healthy heart and preventing secondary cardiac events. Individuals are typically advised to attend cardiac rehabilitation programs after experiencing a major cardiac event, such as a myocardial infarction. However, women and underrepresented racial and ethnic minority (UREM) populations have very low cardiac rehabilitation referral, enrollment, and adherence rates, as they face several barriers that may prevent them from participating in CR. The purpose of this study was to explore disparities in the referral, enrollment, participation, and adherence rates of women and UREM in cardiac rehabilitation programs to understand the factors that may explain their engagement in CR. A systematic review was conducted using Cooper’s five-step process (Whittemore & Knafl, 2005). With the assistance of a health sciences librarian, studies were identified using PubMed and CINAHL to examine disparities in CR for women and UREM populations. A total of 194 articles were screened and 35 articles were included in the final sample. The findings of this study revealed that women were less likely to be referred to, enroll in, participate in, and adhere to cardiac rehabilitation than men. Additionally, results showed that individuals from UREM groups were less likely to be referred to, enroll in, and adhere to cardiac rehabilitation. Interestingly, factors that reflect the social determinants of health and clinician perspectives impacted the participation of women and UREMs in cardiac rehabilitation. Additional research is needed to understand how clinician perspectives may be contributing to the decisions of women and UREM populations from attending cardiac rehabilitation. Additionally, recommendations for clinical practice and organization systems should examine referral processes to ensure that all appropriate individuals have access to cardiac rehabilitation programs, regardless of race, ethnicity, and gender.Bachelor of Scienc