Access is Not Enough: the Redesigning Effective aNd Equitable systems of care for Women’s heart-brain recovery (RENEW)

Heart disease and stroke are major causes of illness among women in Canada, yet many women do not fully benefit from existing cardiac and stroke rehabilitation programs. Women are less likely than men to be referred to rehabilitation, but even when they attend, current rehabilitation care delivery systems are not designed to consider women’s unique biological, mental health, and social needs that critically impact recovery trajectories. The RENEW Network was created to address these gaps and to re-design heart and brain rehabilitation to better meet the needs of women from diverse backgrounds across Canada.

The main goal of the RENEW Network is to improve heart and brain recovery for women by developing care models that recognize sex-specific factors such as menopause, hormone changes, and mental health. Women’s recovery is strongly influenced by psychological health, life stage, social circumstances, and access to culturally safe care. However, simply increasing women’s access to existing rehabilitation programs is not enough - these programs must be redesigned with women’s experiences in mind.

The RENEW Network will focus on several key areas. First, it will generate new evidence about how menopausal and post-menopausal symptoms, reproductive hormone changes, and hormone replacement therapy (HRT) affect women’s recovery after a heart attack or stroke. These topics are currently under-studied, even though the menopausal transition dramatically increases women’s risk and this phase is when many women have cardiac and stroke events. Menopausal factors may have a major impact on recovery outcomes and the RENEW network will advance knowledge of its impacts on physical and mental health, and quality of life for women undergoing cardiac and stroke rehabilitation.

Second, the Network will develop new mental health screening tools specifically designed for women in cardiac and stroke rehabilitation. These tools will be sex- and gender-sensitive, equity-oriented, and culturally safe. Importantly, an Indigenous version of this tool will be co-developed with Indigenous partners and an Indigenous Advisory Circle, ensuring Indigenous knowledge, values, and priorities are respected. The project will also include intergenerationl knowledge sharing about cardiovascular risk and links with mental health, involving direct engagement with Indigenous youth.

Third, the RENEW Network will test innovative rehabilitation and mental health interventions through randomized clinical trials. These include mobile cardiac rehabilitation delivery to increase access to care, brain stimulation treatments for post-stroke depression, and cognitive behavioural therapy to manage sleep disruption and other menopausal symptoms in women recovering from heart disease or stroke.

Finally, the Network will use advanced computer modeling techniques to study and optimize mental health referral pathways from cardiac and stroke rehabilitation programs across Canada. By mapping services and simulating different referral scenarios, the team aims to identify more efficient and equitable ways for women to access mental health care, particularly in rural, remote, and underserved communities.

The RENEW Network brings together clinicians, researchers, Indigenous partners, community leaders, and patient partners from seven provinces. Through collaboration, innovation, and a strong focus on equity, the Network aims to redesign and transform how heart and brain recovery care is delivered for women in Canada.