Elder Women and Cardiac Rehabilitation

Cardiac rehabilitation (CR) is proven to be effective in reducing premature mortality and preventable morbidity. Yet, it is under-utilized. Only one-fifth of Medicare beneficiaries avail themselves of this useful and funded benefit.

Medicare funded an implementation and evaluation of two lifestyle modification demonstration programs (LMPD) that provided an intensive, year-long program of counseling, exercise, nutrition, stress management, and psychosocial support. As a part of this evaluation, a survey was conducted of three groups of patients: patients who did not do any CR, patients who did CR, and patients who did the extended programs. The overall utilization of CR and enrollment into LMPD was low, it was found to be lower still for women. The clinical need for LMPD and CR had been controlled for. Quantitative analyses were performed in LMPD and CR versus those who did not and statistically significant factors were isolated.

More work is needed to understand and address this phenomenon. Literature documents the stress and burden of care-giving for chronic illness on women. Women who joined CR had a poorer risk profile but had equivalent rates of compliance and the same improvement in functioning, arguing for targeted efforts.

As elder persons, and more of them elder women, live longer, live alone, the problem is likely to intensify. Women have less wealth. Statistically significant differences in making use of cardiac care point to factors beyond the control of the medical care system. A community and patient based approach is necessary for humanitarian as well as economic reasons.