Cardiac rehabilitation in older adults
- Nanette K Wenger, MD
Nanette K Wenger, MD
- Professor of Medicine (Cardiology)
- Emory University School of Medicine
- Section Editors
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Following hospitalization for a coronary event such as an acute coronary syndrome or heart failure, all patients, and in particular the elderly, are at increased risk of disability, including a repeat cardiovascular event. The efficacy and safety of cardiac rehabilitation have been demonstrated in all patients in which they have been studied, including the elderly (age >65 years) .
Cardiac rehabilitation promotes physical function, helps overcome disease and deconditioning, as well as related vulnerabilities such as disability, frailty, and falls. Cardiac rehabilitation facilitates education, monitoring, and guidance to reduce iatrogenesis and promote adherence. Further, it fosters cognition, socialization, and independence in older adults .
Cardiac rehabilitation programs are designed to enhance recovery from acute cardiovascular events and to improve both quality of life and survival [3-7]. In addition, patients with stable coronary heart disease treated medically or those who have undergone myocardial revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery derive benefit. (See "Prevention of cardiovascular disease events in those with established disease or at high risk".)
In older patients with heart failure and a preserved ejection fraction, in whom exercise intolerance is the primary chronic symptom, exercise training improves both peak and submaximal exercise capacity . Accumulating evidence has shown comparable exercise training benefits in older and younger patients with heart failure . (See "Cardiac rehabilitation in patients with heart failure".)
Cardiac rehabilitation can play a decisive role in improving function, quality of life, symptoms, morbidity, and mortality in older adults with heart failure, but current policies limit reimbursement for cardiac rehabilitation to patients with heart failure with a reduced ejection fraction .
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