Does cardiac rehabilitation favour the young over the old?

Although cardiac rehabilitation (CR) is a proven intervention in reducing cardiovascular mortality and morbidity there is concern that CR programme delivery may not yield comparable outcomes across age groups.

This study sought to determine if the outcomes achieved after completing CR were influenced by age in patients with coronary heart disease.

Patients were stratified into 2 age groups: young (18-65 years) and elderly (>65 years). Pre-CR and post-CR assessments were used to compute changes in 9 CR outcomes (body mass index (BMI), waist size, hyperlipidaemia, hypertension, smoking, walking fitness, physical activity, anxiety and depression). Pearson's χ(2) test was used to examine the association between the age groups and outcome. Data was extracted from the UK National Audit from July 2010 to June 2015.

A total of 203 012 young patients (55.1±7.9 years, 78% male) and 262 813 elderly patients (76.1±6.9 years, 63.9% male) were analysed. Young patients had a better ratio of improvement across a wide range of risk factors in particular smoking cessation (OR=3.3, p<0.001) while elderly patients had a better ratio of improvement in body shape risk factors BMI (OR=1.3, p<0.001), waist size in women (OR=1.3, p=0.016).

Age is a significant predictor of outcomes following CR. While elderly patients achieve better outcomes in body shape risk factors, younger patients clearly achieve better outcomes across a wider range of risk factors in particular smoking cessation.