The role of sex and age in response to early post-myocardial infarction cardiac rehabilitation.

BACKGROUND

Cardiac rehabilitation (CR) is a key component of secondary prevention after myocardial infarction (MI). However, real-world effectiveness is limited by incomplete uptake and heterogeneity in participation, with persistent disparities affecting women and older adults.

METHODS

This review aimed to synthesize evidence on the role of sex and age in CR participation after MI (initiation, adherence, completion), functional and patient-reported response to CR, and clinical outcomes, and to identify actionable program implications and priority research gaps.

RESULTS

Women and older patients are consistently less likely to initiate and complete CR, and these disparities persist even when referral is documented, indicating barriers beyond referral alone. Among participants, both sexes and all age strata generally improve in functional capacity, but women often enter CR with lower baseline fitness and demonstrate smaller absolute improvements in selected performance metrics. In older adults, functional benefit is commonly observed, but the magnitude and domains of improvement are strongly shaped by baseline performance, frailty-related limitations, sensory and cognitive impairment, and social support. Across broad post-MI and coronary populations, CR participation is associated with lower long-term mortality and reduced hospitalization in multiple cohorts, and recent randomized evidence in vulnerable older post-MI patients supports the clinical impact of multidomain, geriatric-informed CR on hard outcomes.

CONCLUSIONS

Sex and age influence post-MI CR outcomes primarily through differential participation and vulnerability-related constraints rather than absence of benefit. Programs should incorporate sex- and age-focused pathways, including flexible and hybrid- or home-based models, psychosocial integration, and geriatric tailoring. Future studies should standardize outcome reporting and include sex-by-age interaction analyzes to distinguish access effects from true modification of rehabilitation response.