Introduction/Aim. Cardiovascular rehabilitation (CVR) is of utmost importance in primary and (especially) in secondary prevention of coronary artery disease (CAD). The aim of our paper was to examine whether elderly patients with CAD benefit equally from CVR program as CAD patients of younger age. Methods. The study involved 1,697 patients referred to the CVR program after surviving myocardial infarction, percutaneous coronary intervention or surgical myocardial revascularization. Patients were divided in two groups: group I involved patients younger than 65 years (1099 patients, 64.76%), whereas group II comprised patients 65 years old or older (598 patients, 35.24%). At the beginning and at the end of CVR, exercise stress tests were done (EST1 and EST2). Also, the quality of life (QOL) was assessed at the beginning and at the end of CVR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). The results were compared between the groups. Results. Younger patients showed better exercise tolerance on EST1 and EST2. However, both groups showed better exercise tolerance on EST2. Namely, in both groups, patients achieved higher strain level and longer duration on EST2 compared to EST1. Also, higher percentage of patients finished the test by achieving submaximal heart rate on EST2 compared to EST1. Also, our patients showed a significant improvement in all QOL areas except emotional health of patients ≥ 65 of age due to borderline statistically significant limitation. Conclusion. Our study showed that CVR improves the quality of life and physical exercise tolerance in elderly CAD patients. This is why the utilization rate and adherence of these patients to CVR programs should be vigorously encouraged.
References
1.
Gielen S, Hambrecht R. EFFECTS OF EXERCISE TRAINING ON VASCULAR FUNCTION AND MYOCARDIAL PERFUSION. Cardiology Clinics. 2001;19(3):357–68.
2.
Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020;
3.
Malakar AKr, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology. 2019;234(10):16812–23.
4.
Gupta A, Tsang S, Hajduk A, Krumholz HM, Nanna MG, Green P, et al. Presentation, Treatment, and Outcomes of the Oldest-Old Patients with Acute Myocardial Infarction: The SILVER-AMI Study. The American Journal of Medicine. 2021;134(1):95–103.
5.
WHO factsheet “The top 10 causes of death”, updated on 11th. 2021;
6.
Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews.
7.
McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends in Cardiovascular Medicine. 2017;27(6):420–5.
8.
Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2021;28(5):460–95.
9.
Brouwers RWM, Houben VJG, Kraal JJ, Spee RF, Kemps HMC. Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Netherlands Heart Journal. 2021;29(3):151–7.
10.
Lavie CJ, Milani RV. Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and qualify of life in a large elderly cohort. The American Journal of Cardiology. 1995;76(3):177–9.
11.
Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: A meta-analysis. Journal of Cardiology. 2016;68(2):125–34.
12.
Doll JA, Hellkamp A, Ho PM, Kontos MC, Whooley MA, Peterson ED, et al. Participation in Cardiac Rehabilitation Programs Among Older Patients After Acute Myocardial Infarction. JAMA Internal Medicine. 2015;175(10):1700.
13.
Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post–myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American Heart Journal. 2011;162(4):571-584.e2.
14.
Taylor RS, Dalal HM, Zwisler AD. Cardiac rehabilitation for heart failure: ‘Cinderella’ or evidence-based pillar of care? European Heart Journal. 2023;44(17):1511–8.
15.
Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. The American Journal of Medicine. 2004;116(10):682–92.
16.
Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews.
17.
Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. Journal of the American Heart Association. 2018;7(4).
18.
Huang R, Palmer SC, Cao Y, Zhang H, Sun Y, Su W, et al. Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian Network Meta-analysis. Canadian Journal of Cardiology. 2021;37(1):162–71.
19.
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2021(11).
20.
McGregor G, Powell R, Kimani P, Underwood M. Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis. BMJ Open. 2020;10(6):e036089.
21.
Angst F, Giger RD, Lehmann S, Sandor PS, Teuchmann P, Csordas A. Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms. Health and Quality of Life Outcomes. 2022;20(1).
22.
Marchionni N, Fattirolli F, Fumagalli S, Oldridge N, Del Lungo F, Morosi L, et al. Improved Exercise Tolerance and Quality of Life With Cardiac Rehabilitation of Older Patients After Myocardial Infarction. Circulation. 2003;107(17):2201–6.
23.
Stewart KJ, Turner KL, Bacher AC, DeRegis JR, Sung J, Tayback M, et al. Are Fitness, Activity, and Fatness Associated With Health-related Quality of Life and Mood in Older Persons? Journal of Cardiopulmonary Rehabilitation. 2003;23(2):115–21.
24.
Norekvål TM, Allore HG. Cardiac rehabilitation in older adults: is it just lifestyle? Heart. 2020;106(14):1035–7.
25.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2021;42(34):3227–337.
26.
Stojanović M, Deljanin Ilić M, Stevan I. The effects of cardiovascular rehabilitation in patients with reduced, mildly reduced, and preserved ejection fraction-do they benefit equally? Srce i krvni sudovi. 2022;41(2):39–43.
27.
Ralapanawa U, Sivakanesan R. Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. Journal of Epidemiology and Global Health. 11(2):169.
28.
Shahjehan RD, Disease BBSCA. Feb 9. 2023;
29.
Dani SS, Lone AN, Javed Z, Khan MS, Zia Khan M, Kaluski E, et al. Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019. Journal of the American Heart Association. 2022;11(1).
30.
Leong DP, Joseph PG, McKee M, Anand SS, Teo KK, Schwalm JD, et al. Reducing the Global Burden of Cardiovascular Disease, Part 2. Circulation Research. 2017;121(6):695–710.
31.
den Uijl I, van den Berg-Emons RJG, Sunamura M, Lenzen MJ, Stam HJ, Boersma E, et al. Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior, and Physical Fitness: The OPTICARE XL Randomized Controlled Trial. Physical Therapy. 2023;103(9).
32.
Chaves GS da S, Ghisi GL de M, Grace SL, Oh P, Ribeiro AL, Britto RR. Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a randomised controlled trial. Heart. 2019;105(5):406–13.
33.
Deljanin-Ilić M, Kocić G, Lazarević G, Simonović D, Stojanović M, Ilić S, et al. Exercise training and inflammatory markers in coronary artery disease patients. Acta Facultatis Medicae Naissensis. 2022;39(2):173–84.
34.
Stojanovic M, Deljanin-Ilic M, Ilic S, Petrovic D, Ilic B. The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with coronary artery disease. Vojnosanitetski pregled. 2022;79(5):419–26.
35.
Stojanovic M, Vukovic A, Stankovic M, Igrutinovic-Novkovic J, Igic I, Deljanin-Ilic M, et al. Effects of cardiac rehabilitation on quality of life and exercise capacity in patients with coronary artery disease - do women benefit equally? Srpski arhiv za celokupno lekarstvo. 2023;151(5–6):326–32.
36.
Choi HE, Kim C, Lee DJ, Joo JE, Kim HS. Participation and Prognostic Impact of Cardiac Rehabilitation After Acute Coronary Syndrome: Big-Data Study of the Korean National Health Insurance Service. Journal of Korean Medical Science. 38(15).
37.
Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. European Heart Journal. 2023;44(6):452–69.
38.
Deljanin-Ilic M, Stojanovic M, Ilic S. The effect of cardiovascular rehabilitation on physical strain tolerance - does gender really matter? Vojnosanitetski pregled. 2021;78(8):844–50.
39.
Zhang G, Yu C, Zhou M, Wang L, Zhang Y, Luo L. Burden of Ischaemic heart disease and attributable risk factors in China from 1990 to 2015: findings from the global burden of disease 2015 study. BMC Cardiovascular Disorders. 2018;18(1).
40.
Atherton JJ, Sindone A, De Pasquale CG, Driscoll A, MacDonald PS, Hopper I, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart, Lung and Circulation. 2018;27(10):1123–208.
41.
Visseren FLJ, Mach F, Smulders YM. ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC. Rev Esp Cardiol (Engl Ed. 2021;2022;75(5):429.
42.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021;42(36):3599–726.
43.
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41(3):407–77.
44.
Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2022;19(3):180–94.
45.
B.H.F. National Audit of Cardiac Rehabilitation (NACR) Quality and Outcomes Report 2019. 2019;
46.
Redfern J, Gallagher R, O’Neil A, Grace SL, Bauman A, Jennings G, et al. Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Frontiers in Cardiovascular Medicine. 9.
47.
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2021(11).
48.
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019. Journal of the American College of Cardiology. 2020;76(25):2982–3021.
49.
Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of Cardiac Rehabilitation in Women. Journal of Cardiopulmonary Rehabilitation and Prevention. 2021;41(4):207–13.
50.
Braga M, Nascimento H, Pinto R, Araújo P, Nunes A, Rodrigues J, et al. Cardiac rehabilitation in older patients: Indication or limitation? Revista Portuguesa de Cardiologia. 2021;40(1):13–20.
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