Feb. 17, 2026
The first-of-its-kind American Heart Association (AHA) scientific statement on cardiac rehabilitation in women offers insights that could impact clinical practice and policy.
The statement, published in Circulation, addresses the urgent need to improve awareness about the benefits of cardiac rehabilitation for women with cardiovascular disease and increase referral rates so they have access to cardiovascular care.
Cardiac rehabilitation is a lifestyle management program for patients with cardiovascular disease. It involves tailored exercise and behavioral counseling, delivered by a multidisciplinary team of professionals.
Standardizing solutions
"This is the first dedicated scientific statement directly addressing cardiac rehabilitation in women. It represents a collaborative effort with a team of experts to fill long-standing gaps. Cardiac rehabilitation is a high-value, evidence-based intervention, yet participation is consistently lower in women, and persistent sex and gender disparities span referral, enrollment, completion and outcomes. Bringing the evidence and implementation strategies into one framework was necessary to move the field from recognizing the problem to standardizing solutions that health systems can use," says Thais D. Coutinho, M.D., a cardiologist and the newly appointed chair of Preventive Cardiology at Mayo Clinic in Rochester, Minnesota. Dr. Coutinho served as first author and chair of the statement.
Multilevel barriers
Ongoing gaps exist due to obstacles that accumulate across multiple levels. Women are less likely to be referred. If referred, they often face competing caregiving and work demands. Then, there are transportation challenges, cost barriers, and higher medical and psychosocial comorbidity that can make participation difficult.
"These barriers are not evenly distributed. Women from racial and ethnic minority groups face additional structural obstacles, including lower likelihood of receiving a clinician recommendation and greater financial blocks, which worsen inequities in access and completion," says Dr. Coutinho.
Actionable insights
The statement outlines strategies to help improve outcomes and promote equity in cardiovascular care:
- Make referral reliable and routine through automatic referral pathways coupled with case management or a navigator model.
- Advocate for hybrid program designs that fit women's lives.
- Integrate psychosocial assessment, mental health interventions and peer support.
"Lower participation among women has been linked to the perception of exercise as unpleasant, a discomfort with group-based formats and a preference for alternatives to traditional facility-based cardiac rehabilitation. Offering virtual, home and community-based cardiac rehabilitation options reduces these barriers," says Demilade A. Adedinsewo, M.D., a cardiologist at Mayo Clinic in Jacksonville, Florida, and a member of the AHA scientific statement writing group.
"Women often have greater psychosocial needs, including higher rates of depression, anxiety and limited social support. Incorporating mental health services, peer support programs, culturally sensitive educational materials and tailored exercise prescriptions, including modalities preferred by women like dance and yoga, significantly improve engagement and outcomes," says Dr. Adedinsewo.
The statement has the potential to impact clinical practice. "I expect this work to accelerate the shift from opportunistic, clinician-dependent referral toward standardized pathways, with broader acceptance of novel models that reduce logistical barriers for women," says Dr. Coutinho.
This is important because cardiac rehabilitation participation is associated with clinical benefits, including:
- Reductions in readmissions.
- Lower long-term cardiovascular events and mortality.
- Improved quality of life.
"Closing the participation gap is a direct route to better outcomes and more equitable care," says Dr. Coutinho.
What's next
The central priority is implementation at scale:
- Embedding automatic referral with navigation support.
- Expanding flexible delivery models.
- Building culturally responsive programming with accountability metrics to ensure participation gaps narrow.
"We still need stronger evidence in women for nontraditional rehabilitation delivery and for diagnosis-specific rehabilitation approaches in conditions that disproportionately affect women," says Dr. Coutinho. "Such evidence is key combined with pragmatic studies that test which health system and community strategies most effectively improve enrollment, completion and outcomes across diverse populations."
For more information
Coutinho T, et al. Cardiac rehabilitation in women: A scientific statement from the American Heart Association. Circulation. 2025;152:e376.
Refer a patient to Mayo Clinic.