Background and Aims: Cardiac rehabilitation (CR) is of proven mortality and, or morbidity benefit following myocardial infarction (MI), angioplasty (PTCA), or coronary artery bypass graft (CABG). Previous investigations have reported that women have been underrepresented in CR trials, and thus any conclusions drawn from these trials may not be applicable to women. However, the vast majority of reports examining these issues were limited by not carefully and prospectively examining the number of both women and men potentially eligible for the CR trials and the factors related to lack of enrolment into the CR trials. The aim of this investigation was to establish which factors played a role in the sign-up rate to the CR participation study, a large RCT involving a brief in-hospital intervention (personalized written MD endorsement) to improve CR participation among a sequential cohort of patients hospitalized for MI, PTCA, or CABG in a large tertiary care hospital.

Methods and Materials: From May 2003 through March 2006, 1,064 consecutive women and 2,212 men who were hospitalized for MI, PTCA, or CABG were screened for entry into the CR participation study. Frequencies of select CR participation study exclusion criteria (personal preference, inability to exercise, place of residence > 1-hour drive from CR center, prior CR enrolment, non-English speaking, planned CABG or PTCA within 2 months of discharge) were compared across gender.

Results: Overall of those screened, 166 women and 367 men (15.6% vs 16.6%, P = NS) were eligible for, and enrolled in the CR participation study. More women (173) than men (171) were excluded because of reported inability to exercise (16.3% vs 7.7%, P < .0001). Fewer women (450) than men (1,051) were excluded because of place of residence more than 1-hour drive from CR center (42.3% vs 47.5%, P = .006), and prior CR program enrolment (23 (2.2%) women vs 85 (3.8%) men, P = .012). There were no significant differences in frequency of the remaining exclusion criteria between women and men.

Conclusions: Overall we found no difference in the proportion of consecutively screened potentially eligible women and men hospitalized for MI, PTCA, or CABG who signed up for enrolment in a large CR study. Comments concerning gender bias in recruitment for CR studies should not be made without taking into account the gender breakdown and reasons for study nonparticipation among potentially eligible women and men.