BACKGROUND: Cardiac rehabilitation (CR) is underutilized, especially among women. The goal of this study was to examine CR referral and enrollment patterns among eligible women and identify factors associated with utilization. METHODS: The sample included women (n = 131) hospitalized with an eligible CR diagnosis between April 2001 and August 2002. Inpatient interviews were conducted to explore the perceptions of women about CR. Demographic and clinical characteristics were compared between women who were referred and those who were not referred to CR. Enrollment to CR was ascertained more than 60 days postdischarge. Among referred women, clinical and demographic characteristics and perceptions about CR were compared between women who enrolled and those who did not enroll. Separate multivariate regression analyses identified factors associated with (1) referral to CR and (2) enrollment in CR among women who had been referred. RESULTS: There were 77 (59%) women referred to CR. In the final regression model, no demographic or clinical factors were found to be associated with CR referral. Among the women referred to CR, 34% enrolled in CR. In the final regression model, it was found that nonenrollees had lower education levels (<12 years) than did enrollees, and women who enrolled were more likely to give the highest score for "likely to attend CR" during the interview compared with nonenrollees (P < .05). CONCLUSION: CR referral and enrollment rates among women remain disappointingly low. Societal barriers, such as low education, often impede CR participation. However, intent to enroll as expressed by the patient may be amenable to an intervention during the hospital stay.