Womens health-related quality of life substantially improves with tailored cardiac rehabilitation: a systematic review and meta-analysis

Type of funding sources: None.

Women have poorer outcomes from coronary heart disease (CHD) compared to men and participation in exercise-based cardiac rehabilitation (EBCR) offers an opportunity for improvement. However, synthesised evidence for women-specific patient-reported outcomes are often lacking. We aimed to synthesise HRQL outcomes from EBCR in women with CHD.

Four electronic databases (PUBMED, CINAHL, SCOPUS and Cochrane) were searched for studies reporting HRQL using validated measures in women attending EBCR. Two reviewers independently screened papers and extracted data. Random effects model (RevMan v5.4) was used for analysis.

Eleven studies (1292 women participants) were included: six observational, three randomised controlled trials, and two quasi-experimental design. Seven studies were included in the meta-analyses. EBCR participation was associated with HRQL benefits in several domains of the Short-Form (SF-12 or 36). Improvements were greatest in Role Physical (MD 19.09 95% CI 2.37, 35.81), Physical Functioning (MD 10.43, 95% CI 2.60, 18.27) and Vitality (MD 9.59, 95% CI 0.31, 18.86). When tailored components were added to traditional EBCR, gains in HRQL were also observed, specifically in Bodily Pain (MD 9.82, 95% CI 4.43, 15.21), Role Physical (MD 8.48, 95% CI 1.31, 9.97), Vitality (MD 8.17, 95% CI 3.79, 12.55), General Health (MD 5.64, 95% CI 1.31, 9.97), and Physical Function (MD 5.61, 95% CI 0.83, 10.40) domains.

Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, and additional benefits were seen when strategies tailored to their needs and preferences were included. Future research should focus on promoting EBCR uptake in women.