Jennifer L. Reed

Aims: We aimed to assess the temporal trends in sociodemographic characteristics, cardiometabolic risk factors, and health behaviours among patients enrolled in cardiovascular rehabilitation (CR) between 2001 and 2025. Methods: A retrospective cohort study of patients with cardiovascular diseases who enrolled in a CR program at Canada's largest cardiovascular health centre between 2001 and 2025. Baseline measures included sociodemographic variables, cardiometabolic risk factors, physical activity, smoking status, nutritional profile, and mental health factors. Results: Among 40,822 participants (mean (SD) age, 63 (13) years; 30.7% females; 59.5% with coronary artery disease), sociodemographic diversity significantly increased over the two decades. A significant temporal trend toward older age with participant age increasing by 0.3 years annually (p < 0.001). Participants also had progressively greater odds of being female (OR=1.004; 95% CI: 1.001-1.008; p = 0.02), non-White (OR=1.02; 95% CI: 1.01-1.03; p < 0.001) and not married (OR=1.02; 95% CI: 1.02-1.03; p < 0.001), while the odds of being occupationally inactive decreased over time (OR=0.95; 95% CI: 0.94-0.96; p < 0.001). Atherosclerotic coronary artery disease was the predominant cardiovascular condition (59%), followed by valvular heart disease (14%) and arrhythmias (10%). Significant annual decreases were observed in systolic blood pressure (-0.37; 95% CI: -0.41 – -0.33; p < 0.001) and LDL cholesterol (-0.02; 95% CI: -0.02 – -0.02; p < 0.001). The odds of low moderate-to-vigorous physical activity (OR=0.98; 95% CI: 0.98–0.99; p < 0.001) and moderate-to-high anxiety symptoms (OR=0.98; 95% CI: 0.98–0.99; p < 0.001) also declined over time. Conclusion: Despite encouraging trends toward greater diversity, females, non-White individuals, and those with lower educational attainment remain underrepresented in CR, highlighting persistent equity gaps in enrollment. Additionally, encouraging improvements were observed in key cardiometabolic and behavioural risk factors, including lower blood pressure and LDL cholesterol levels, reduced physical inactivity, and fewer anxiety symptoms.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality globally, underscoring the need for comprehensive prevention and rehabilitation strategies. Cardiovascular rehabilitation (CR) programs are multidisciplinary, addressing risk factor management, physical activity (PA), smoking cessation, psychosocial care, and nutritional counselling to support recovery, enhance quality of life (QoL), and reduce secondary CVD events. Over the previous several decades, CR has evolved from inpatient care in hospitals to community-based, home-based, and virtual models, driven by efforts to improve accessibility and equity. Research has advanced program design, including optimal duration, contact frequency, and referral strategies, while expanding preventive approaches to families and high-risk populations. Digital health technologies, including telehealth, wearable devices, and AI-enabled tools, are increasingly integrated to personalize care and extend reach. Innovations in exercise delivery such as high-intensity interval training, Nordic walking, and strength training aim to enhance engagement and physical and mental health outcomes. Smoking cessation interventions such as the Ottawa Model for Smoking Cessation improve patient outcomes and reduce recurrent CVD events. Psychosocial care, delivered through stepped-care models and interventions such as cognitive behavioral therapy and stress management, enhances mental health and adherence. Established dietary patterns, including Mediterranean and DASH diets, are complemented by innovative approaches such as time-restricted eating and pharmacotherapy to support weight management and cardiovascular health. Collectively, these advancements reflect a global shift toward personalized, inclusive, and technology-enabled care designed to reduce disparities, extend CR benefits to broader populations, and improve adherence to heart-healthy behaviours.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, predominantly affecting women. Psychological distress is common pre- and post-SCAD, yet sex-specific patterns remain understudied. This cross-sectional study aimed to examine sex differences in the psychological distress of patients with SCAD. METHODS: Adult patients diagnosed with SCAD within the past 3 years, confirmed by coronary angiography, were recruited from 6 Canadian hospitals between April 2022 and January 2025. Participants completed questionnaires assessing sociodemographics and validated measures of psychological distress: Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for generalized anxiety, Cardiac Anxiety Questionnaire for cardiac-related anxiety, and PTSD Checklist-5 for posttraumatic stress symptoms. Sex differences were analyzed using t tests for continuous variables and χ ² tests for categorical variables. Multivariable linear regression models assessed the association between sex and psychological distress, adjusting for age, pre-SCAD mental health diagnosis, and employment status. RESULTS: Among 326 patients (92.9% women; mean age=53.3±11.1 years), women reported higher rates of preexisting mental health conditions (29.2% versus 8.7%; P =0.035). Post-SCAD women reported higher mean scores than men on the Patient-Health-Questionnaire-9, Cardiac-Anxiety-Questionnaire, and PTSD Checklist-5 (all P P =0.010), cardiac anxiety (B=7.09; P =0.008), and posttraumatic stress symptoms (B=5.94; P =0.048) after adjustment. Clinically significant symptoms were more common in women versus men: 25.1% versus 0% (depression), 21.5% versus 4.4% (anxiety), 54.8% versus 26.1% (cardiac anxiety), and 15.5% versus 0% (posttraumatic stress). CONCLUSIONS: Both women and men experience clinically significant cardiac anxiety following SCAD, but women report a greater psychological burden, including more preexisting mental health conditions and twice the distress after SCAD. These results underscore the importance of routine psychological screening and timely intervention to support mental health and recovery outcomes, particularly among women.

Physical activity (PA) benefits young adults living with and beyond cancer, yet participation remains low. This pilot randomized controlled trial (RCT) evaluated the feasibility and acceptability of a PA behavior counseling intervention for young adults post-cancer treatment and trial methods. A mixed-methods, open-label, parallel, two-arm pilot RCT was conducted with young adults recruited nationwide (Canada) by healthcare provider referral or advertising. Eligible participants were 18–39 years (with a first diagnosis of invasive, non-metastatic cancer at age 18–39 years), had completed active treatment for invasive, non-metastatic cancer < 5 years prior, self-reported < 150 min of moderate-to-vigorous intensity PA weekly, were fluent in English, and had access to/computer literacy for videoconferencing technology. Young adults were randomized to receive a 12-week individualized PA behavior counseling intervention delivered via videoconferencing technology by PA counselors or usual care. Informed by self-determination theory, the intervention emphasized autonomy support and applied motivational interviewing. Staff tracked feasibility and acceptability outcomes regarding enrollment, allocation, retention, adherence, and adverse events. Young adults and PA counselors were interviewed post-intervention (T1; primary endpoint) and at trial completion, respectively. Planned efficacy outcomes were assessed using accelerometers and online surveys at baseline (T0), T1, and follow-up (T2; secondary endpoint; 24 weeks post-baseline). Seventy-four young adults were screened for eligibility (recruitment rate ~ 4/month over 18 months); 47 (63.5%) were eligible, of which 42 (89%) consented, completed T0 assessments, and were randomized. Most (75% [15/20]) allocated to receive the intervention completed all sessions. Retention rates were 85.7% (T0 to T1 [36/42]) and 71.4% (T0 to T2 [30/42]). Analyzable data for the primary efficacy outcome (PA behavior) were available for 57.1% (24/42) at T1. Content analysis of interviews with 35 (80.0%) young adults and both (100.0%) PA counselors yielded three themes reflecting factors that positively impacted intervention acceptability and one theme reflecting factors that negatively impacted the trial methods’ acceptability, as well as recommendations to optimize the trial methods and intervention. The trial methods and intervention were largely feasible and acceptable for young adults post-cancer treatment, although modifications are required to optimize recruitment strategies, enhance retention at follow-up, refine the intervention, and reduce missing data. A full-scale RCT to assess the efficacy of the intervention and estimate concomitant costs is warranted. ClinicalTrials.gov (ID: NCT04163042). Registered on November 14, 2019.

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of heart attacks, particularly for female patients; however, ∼10% of cases occur in male patients. While male and female differences pertaining to clinical outcomes and treatment protocols have been addressed in the literature, research is limited on sex differences in secondary prevention programming, such as cardiac rehabilitation. Cardiac rehabilitation is recommended for patients with SCAD to promote physical and mental recovery. This letter highlights sex-specific gaps in existing programming and reports patients’ suggestions for enhancing the recovery of this unique patient population.