Comprehensive cardiac rehabilitation in elderly patients with heart failure: age is just a number?

Background Growth of older population leads to a high burden of cardiac disease, geriatric syndrome and other comorbidities. Cardiac rehabilitation (CR) is a personalized complex secondary prevention program which improves exercise tolerance, psychological well-being and quality of life. Several studies reported the benefits of CR for several cardiovascular disease, including heart failure (HF), but unfortunately remains underutilized among older patients due to frailty and disability. Purpose This study aims to assess the clinical impact of comprehensive phase II CR program among older ((≥60 years) patients with HF. Methods This was a prospective study which enrolled 41 patients with HF who have completed 8 supervised CR session, 2 times per week, which consisted of psychological, diet and nutritional counselling, stretching, moderate intensity aerobic and resistance training with heart rate calculated using the Karvonen formula and intensity of 12 to 13 on the Borg Scale as a threshold. The data of medical history including co-morbidities, cardiovascular risk factors and lifestyle were collected. We compared and analysed changes after CR program in metabolic profile (body mass index, lipid, uric acid and A1C profile), autonomic nervous system function (resting heart rate), and quality of life (physical and emotional components) which assessed with Minnesota living with HF questionnaire (MLHFQ). Analysis was done using Statistical Package for the Social Sciences (SPSS) v.22 (IBM-corps, Armonk NY) software. Qualitative variables were compared by chi-square test. Paired sample T-Test was using to compare quantitative variables before and after CR program. Results Among 41 patients, there were 18 (44%) older patients and 12 (67%) were males. This study showed significant reductions in older patient’s LDL cholesterol level (126.06±25.9 vs 93.61±17.23, p<0.001). Post training data showed improvement in older patient’s exercise capacity (313.7±72.3 METs vs 385.3±65.3 METs, p<0.001), quality of life which consist of physical component (34.3±1.5 points vs 18.5±1.5 points, p<0.001), emotional component (6.8±1.2 vs 5.17±0.8, p=0.001) and lower resting heart rate (67.3±9.1 vs 63.7±6.9, p=0.141). There were not reported any adverse events in this study. Conclusions Elderly patients with HF get benefit from CR program, similarly to younger patients. Under-enrolled of CR in elderly patients remains entrenched. Repeatedly encouragement and individualized exercise prescription must be given to increase the CR enrollment and implementation. Baseline Characteristics of the Study Comparison of Changes within-group