Only one in four Medicare patients made use of cardiac rehabilitation after a heart attack, acute heart event or surgery, according to a recent study.

Participation was particularly low among women, the elderly and non-white patients, reported lead study author Matthew D. Ritchey, P.T, from the Centers for Disease Control and Prevention. Moreover, participation decreased with increasing age: only 10% of patients ages 85 and older used the benefit, compared with about 32% of those ages 65 to 74, Ritchey wrote.

Among those who did attend rehab sessions, only about 27% completed the full course of 36 or more sessions.

Ritchey and his colleagues highlighted the systematic, logistical and cultural barriers to attending and completing an outpatient program. They recommend that clinicians help improve awareness of the value of cardiac rehabilitation and refer more eligible patients.

The investigation was published Tuesday in Circulation: Cardiovascular Quality and Outcomes.