Cardiac rehabilitation for old-old patients with heart failure and severe functional impairment

Area of Science:

• Cardiology
• Geriatrics
• Rehabilitation Medicine

Background:

• Cardiac rehabilitation (CR) benefits for elderly heart failure (HF) patients with severe functional impairment are not well-established.
• Severe functional impairment in HF is often defined by a limited six-minute walking distance (6MWD).

Purpose of the Study:

• To evaluate the effectiveness of CR in improving functional capacity in older patients with HF and severe functional impairment.
• To assess the association between functional improvement post-CR and three-year mortality.

Main Methods:

• A cohort of 1397 patients with HF and severe functional impairment (6MWD <300 m) admitted to inpatient CR was analyzed.
• Patients were stratified into three age groups: young (≤65 years), old-young (66-75 years), and old-old (>75 years).
• Multivariable Cox modeling was used to determine the impact of achieving a 6MWD ≥300 m on three-year mortality.

Main Results:

• A significant proportion of patients in all age groups were initially unable to walk unassisted.
• While the ability to walk independently was regained by a substantial percentage across groups, achieving the primary outcome (6MWD ≥300 m) varied significantly by age group (49.1% in young, 32.2% in old-young, 15.7% in old-old).
• Achieving the primary outcome was associated with a reduced risk of three-year mortality across all age groups, including the old-old (adjusted HR 0.68).

Conclusions:

• Cardiac rehabilitation offers benefits for older heart failure patients with severe functional impairment.
• Functional improvement achieved through CR is a significant predictor of improved survival in this patient population.
• Even the oldest patients (>75 years) with severe functional impairment can benefit from CR, with functional gains linked to better long-term outcomes.