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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac Rehabilitation Is Associated With Improved Physical Function in Frail Older Adults With Cardiovascular
Andrew H Lutz1, Amanda Delligatti, Kelly Allsup
1Geriatric Research, Education, and Clinical Center (Dr Forman), Veterans Affairs Pittsburgh Healthcare System (Drs Lutz and Forman and Mss Delligatti and Allsup), Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Lutz and Forman); Jewish General Hospital, McGill University, Montreal, Quebec, Canada (Dr Afilalo); and University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Forman).
Insights
Cardiac rehabilitation (CR) offers significant benefits for frail older adults with cardiovascular disease (CVD), improving physical function similarly to non-frail individuals. These findings support CR referrals for all eligible patients, including the frail.
Area of Science:
- Gerontology
- Cardiology
- Rehabilitation Medicine
Background:
- Frailty is common in older adults with cardiovascular disease (CVD), increasing morbidity and mortality risk.
- Frail patients are often excluded from cardiac rehabilitation (CR) due to assumptions about their inability to benefit.
Purpose of the Study:
- To investigate the hypothesis that CR provides similar benefits for frail adults as for intermediate-frail and nonfrail adults.
- To evaluate the impact of CR on physical function in frail versus non-frail CVD patients.
Main Methods:
- Retrospective analysis of 243 CVD patients completing phase II CR.
- Frailty assessed using Fried criteria, including 6-min walk distance, gait speed, tandem stand, Timed Up & Go (TUG), and grip strength.
- Comparison of pre- and post-CR measures within and between frail, intermediate-frail, and nonfrail groups.
Main Results:
- All groups showed improvements in frailty measures, except tandem stand.
- No significant differences in 6-min walk distance, gait speed, tandem stand, or grip strength improvements between groups.
- Frail patients demonstrated significantly greater improvement in TUG compared to other groups (P = .007).
Conclusions:
- Cardiac rehabilitation is associated with improvements in physical function for frail patients.
- Frail individuals achieved similar or greater gains from CR compared to intermediate-frail and nonfrail patients.
- These findings strongly support the referral of all eligible patients, including frail individuals, to CR programs.
Purpose:
Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and is associated with greater than 2-fold risk for morbidity and mortality, independent of age and comorbidities. Many candidates are not referred to cardiac rehabilitation (CR) under the assumption that they are too frail to benefit. We hypothesized that CR is associated with similar benefits for frail adults as for intermediate-frail and nonfrail adults.
Methods:
Retrospective analysis of CVD patients who completed a phase II CR program. Patients classified as frail by meeting ≥2 frailty criteria and intermediate-frail by meeting 1 criterion, including 6-min walk distance (6MWD) <300 m, gait speed ≤0.65 m/sec or 0.76 m/sec normalized to height and sex, tandem stand <10 sec, Timed Up & Go (TUG) <15 sec, and weak hand grip strength per Fried criteria. Changes within and between groups were compared before and after completion of CR.
Results:
We evaluated 243 patients; 75 were classified as frail, 70 as intermediate-frail, and 98 as nonfrail. Each group improved in all measures of frailty except for tandem stand. There were no significant differences in pre- to post-CR measures for 6MWD, gait speed, tandem stand, or hand grip strength between groups. Frail patients showed greater improvement in TUG than the other groups (P = .007).
Conclusion:
Among frail patients, CR was associated with improvements in multiple domains of physical function. Gains achieved by frail adults were similar to or greater than those achieved by intermediate-frail and nonfrail patients. These data provide strong rationale for referring all eligible patients to CR, including frail patients. Those who are most physically impaired may derive gains that have proportionally greater ramifications.
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