A brighter future for disadvantaged women needing cardiac care



Women living in rural and remote areas with cardiovascular disease will benefit greatly from a new co-designed model of care led by researchers from Flinders Caring Futures Institute.

The Cardiac Rehabilitation Especially for Women (CREW) project aims to improve secondary prevention and survivorship for women through improving their attendance and the clinical outcomes of cardiac rehabilitation (CR).

Associate Investigator Dr Joyce Ramos says the CREW project, which has now entered its final six-month stage of development, will become a valuable telehealth-enabled model of care that can be rolled out across Australia.

“It is so rewarding to be involved in a project with high-calibre researchers and clinicians in cardiac rehabilitation, knowing that the project outcomes are readily translatable in clinical practice to improve cardiac health and quality of life for disadvantaged women with cardiovascular disease (CVD),” says Dr Ramos.

Dr Joyce Ramos

The CREW project – which also features co-investigators Dr Alline Beleigoli, Dr Lemlem Gebremichael, Dr Norma Bulamu, PhD candidate Orathai Suebkinorn and Associate Professor Claire Drummond – addresses earlier Flinders University research that indicates South Australian women are 20% less likely to enrol in a cardiac rehabilitation program than men. This problem is amplified in rural areas, where cardiac disease risk factors such as smoking and diabetes are reported to be up to 1.6 times higher in women.

The combination of these disturbing factors led to the CREW project being funded by The Hospital Research Foundation, to best understand and act on the needs and preferences of women living in rural South Australia, and for all parties to help co-design an effective web-based Cardiac Rehabilitation program.

The new model of care is being designed after reviewing and collecting data from women in six rural regions of South Australia – Port Lincoln, Nuriootpa, Wallaroo, Mount Gambier, Murray Bridge and Whyalla. Tailored around an existing web-based cardiac rehabilitation program, the new and improved model’s testing phase will be completed by March 2023.

Findings from Phase 1 of the CREW study have identified six themes of concern to the women who were interviewed, which include the costs associated with attending face-to-face CR sessions; access to CR nurses to support patient care; early education about bra requirements for early wound management after cardiac surgery; and concise educational sessions that can be delivered by a variety of mediums including videos, texts and podcasts.

The next phase of the research, which starts in April 2023, will compare CREW’s impact on the attendance and completion rates of rehabilitation by women in rural and remote areas against a matched cohort.

To capture the project’s impact on patient health outcomes, the CREW researchers will be able to measure its effectiveness on CVD risk factor, re-hospitalization, death, and patient-reported outcomes relating to social support, health literacy and health-related quality of life.

“Given the importance of the problem, and the strong track record of the team, future trials would be highly likely to attract further funding,” says Dr Ramos.

A national roll-out of the CREW project would involve leading organisations and key partnerships in cardiac rehabilitation, including Integrated Cardiovascular Clinical Network South Australia (iCCnet SA), six regional local health networks, Heart Foundation (through Associate Investigator Imelda Lynch), Health Translation SA (through Associate Investigator Wendy Keech), and Australian Cardiac Rehabilitation Association (through Associate Investigator Professor Jeroen Hendriks).

In the longer term, the CREW project could see telehealth models of care implemented internationally, underlining the value of this research to introduce positive change to the lives of disadvantaged women, especially those living in rural areas.

“Our team has been inspired by this opportunity to make a difference in the lives of millions of women who have cardiovascular disease,” says Professor Robyn Clark, Professor of Research at Flinders University’s College of Nursing and Health Sciences.

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Cardiac Health