Ambulatory cardiac rehabilitation in elderly patients after coronary revascularization: one-year follow up and outcome

Abstract

Purpose: From January 2009 to May 2010, we included in a registry 520 patients (pts) discharged from Cardio-Surgical Department admitted to Cardiac Rehabilitation (CR) for ambulatory program (AP) of CR and secondary prevention (SP). The aim of this analysis is to describe the differences between pts >75 years (Group 1) and younger than 75 years (Group 2) in term of adherence to CR program, baseline characteristics, target values of SP reached, outcome at one-year follow-up (1Y-FUP). Methods: All 520 pts (mean age 68±11 y) with STEMI/NSTEMI/PTCA/CABG (with/without valvular surgery) were admitted. The AP includes nurse, dietetic and psychological counseling, physical training, quit smoking program and repeated clinical and instrumental evaluations. The program lasted 5,2±4 months and we analyze 1Y-FUP. Results: 145 patients (27.8%) were in Group 1 [M 76 (52%) F 69 (48%), mean age 80±3.9 y)], while 375 in Group 2 [M 273 (73%) F 102 (27%), mean age 63±8.5] with STEMI/NSTEMI/PTCA/CABG (26 vs 28%, 19 vs 16%, 23 vs 23%, 32 vs 33%). At baseline, comparing Group 1 and Group 2: 24% vs 20% had previous acute coronary syndromes (ACS), 9% vs 2.2% history of atrial fibrillation (p=0.000), 23.6 vs 19% were in NYHA 2-3, 13.6 vs 8.6% had an ejection fraction < 40%, 32.4 vs 33.2% were diabetic, 27.2 vs 10.4% had chronic renal failure (p=0.000), 87 vs 72% had arterial hypertension, 15 vs 8% had COPD (p=0.02), 21 vs 8.5% had previous in-hosptial CR for 2 weeks (p=0.000), 18.6 vs 35.7% were smokers (p=0.000). At the end of the RP, laboratory findings in the 2 groups: LDLc 88±29 vs 85.9±29 mg/dL, Hb A1c 6,2±0.7 vs 6.3±1.1%; systolic/diastolic arterial blood pressure was: 140±18/76±9 vs 135±18/78±9 mmHg, heart rate was 66±10 vs 65±9 bpm, 13 vs 23% quit smoking (p=0.000). Use of beta-blockers/ACE inhibitors/ASA/Statins at the end of RP was respectively: 66 vs 72%/70 vs 67%/97 vs 97%/85 vs 92% (p=0.012). EF remained <40% in 9.8 (p=0.04%) in group 1 vs 5.8% (p=0.04). At 1Y-FUP, a new hospitalization for ACS occurred in 2.3% of cases in both groups. Total deaths (TD) were 7.3 vs 3% (p=0.033) and cardiovascular deaths (CVD) 2.9 vs 0.5% (p=0.027). Only 2 pts vs 4 pts did not complete RP. Conclusions: A program of ambulatory CR and SP is feasible and effective even in pts older than 75 years. In our cases, pts of group 1 showed higher prevalence of NSTEMI, higher profile of comorbidities and advanced NYHA class. Both groups reached the target values for SP, optimizing medical therapy, and also EF was equally improved. At 1Y-FUP mortality was low in both groups even if TD and CVD were higher in elderly pts.