A web-based program designed specifically for women, known as Cardiac Rehabilitation Especially for Women (CREW), aims to enhance access to cardiac rehabilitation services in rural and remote areas of South Australia. The initiative was created under the Country Heart Attack Prevention project, which is led by Flinders University.
The digital platform consists of four primary sections: program orientation, self-reported health assessments, education based on clinical guidelines for cardiac rehabilitation, and content tailored to women’s cardiovascular health. According to Professor Robyn Clark, a member of the CREW project team, the development process involved co-creation with 19 women from rural South Australia who had previously undergone cardiac rehabilitation.
Program Details
Material within the program is categorized into streams focusing on acute coronary syndromes, heart failure, arrhythmia, and cardiothoracic surgery. Optional modules are also available to address smoking and alcohol consumption. Users may self-enroll to access multimedia content at their own speed via smartphones, tablets, or computers, and no specialized hardware is required.
Features of the platform include short quizzes and digital records that monitor progress through the modules. Participants expressed high levels of satisfaction with various aspects, particularly regarding caregiving responsibilities, emotional health, and information regarding gender-specific heart attack symptoms.
Study Findings
The CREW team conducted a study to evaluate the feasibility of delivering and accepting the program among women suffering from cardiovascular disease and clinicians operating in rural and remote communities. The research involved 40 participants referred to cardiac rehabilitation through South Australia’s integrated Cardiovascular Clinical Network between November 2023 and November 2024.
Results published in Heart, Lung and Circulation indicated that 33 out of 40 participants (82.5%) began cardiac rehabilitation, compared to 64 out of 114 women (56.1%) in the control group. Additionally, 24 of the 40 participants (60%) finished the program, versus 52 of the 114 women (45.6%) in the control group.
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Interviews with participants and clinicians revealed that the approach was generally feasible and acceptable. Both groups valued the ability to access rehabilitation at a location and time that suited them. Professor Clark noted that the program helps women adopt recommended behaviors for managing their disease and addresses their specific needs.
Barriers and Improvements
Both participants and clinicians identified challenges such as low digital literacy, unstable internet connections, staffing shortages, and technical glitches as obstacles. A subset of participants expressed a preference for face-to-face or booklet-based rehabilitation over a purely online model. Suggestions for enhancement included automated notifications, AI features to boost engagement, and more detailed usage statistics.
The researchers also proposed investigating the program’s adaptability for culturally and linguistically diverse populations. Furthermore, the study did not determine if CREW effectively alters cardiovascular risk factors, physical exercise capacity, quality of life, or long-term health habits. To assess clinical efficacy conclusively, the authors recommend a larger, adequately powered controlled study.
Women are statistically less likely than men to enter cardiac rehabilitation following a cardiovascular event. Professor Clark referenced broader Australian and international statistics, noting that being female is a significant independent predictor of lower referral rates, resulting in women having lower odds of being referred across various cardiac diagnoses.
In rural regions, access is further hampered by geographic distance, rigid scheduling, work and caregiving obligations, and a scarcity of rehabilitation choices. The CREW program was constructed to offer supplementary options rather than replace existing services. The CREW team is currently collaborating with the women’s heart health nonprofit Her Heart to further develop and implement the initiative.
The Country Heart Attack Prevention project, led by Flinders University, plans to continue refining CREW based on feedback from participants and clinicians. They also intend to explore adaptations for diverse populations. The alliance with Her Heart will focus on expanding access and increasing participation among women.
