Cardiac rehabilitation: does age matter?

Abstract

Purpose: Although a great proportion of patients with coronary heart disease have more than 65 years old, frequently they are not included in the studies and are less likely to be referred to a Cardiac Rehabilitation Program (CRP). Our aim was to study the effectiveness of CRP in this age range. Methods: We studied 904 consecutive patients that participated in our multidisciplinary CRP. From those, we enrolled patients with known coronary heart disease, after acute coronary syndrome or elective revascularization (729 patients). The subjects performed 45 minutes of supervised aerobic exercise during approximately 12 weeks, 2/week. We measured different laboratory and clinical parameters at the beginning and at the end of the CRP, including a treadmill stress test. A cut-off of 65 years-old was used to dichotomize age. The proBNP levels, maximal exercise capacity, heart rate reserve and chronotropic recovery were evaluated as prognostic markers to access the benefits of the CRP. Results: Approximately 36% of our patients had more than 65 years-old and 75% were male. At baseline, older patients had higher proBNP levels (1253(plus or minus)1802 pg/mL vs 530(plus or minus)590 pg/mL; p<0,001) and lower functional capacity (7,23(plus or minus)2,1 METs vs 9,7(plus or minus)6,29 METs; p<0,001). The heart rate reserve and chronotropic recovery were significantly better in younger patients (51,6(plus or minus)9,4% vs 47,2(plus or minus)10,7%, p<0,001; 23,6(plus or minus)11,1 bmp vs 18,3(plus or minus)8,8 bmp, p<0,001). After the CRP, there was a statistically significant improvement in proBNP levels, maximal exercise capacity, heart rate reserve and chronotropic recovery in both groups. The degree of improvement in heart rate reserve and chronotropic recovery was similar between the groups. Likewise, the change in functional capacity after CRP was not statistically different, but interestingly there was a trend for a greater improvement in older patients. The improvement in proBNP was also higher in elderly patients (-633(plus or minus)78 pg/mL vs -260(plus or minus)23 pg/mL, p<0,001). Conclusions: The benefits of cardiac rehabilitation in terms of functional capacity and prognostic markers were comparable, and even more expressive, in elderly patients. However, since they had lower values at baseline, they could have a greater potential for improvement. Therefore, if these patients don't have limitations that unable them to participate in a CRP, they should be strongly encouraged to perform systematic and initially supervised exercise training. Cardiac Rehabilitation is an important secondary prevention strategy in coronary heart disease patients, regardless of age.