Does age matter? - insights from a cardiovascular rehabilitation program

Background Cardiovascular rehabilitation (CR) consists of a patient-centered, multidisciplinary program that has demonstrated multiple benefits in secondary prevention. Misconceptions about older patients may lead to lower referral rates. Purpose To describe the differences in baseline characteristics, clinical findings, blood analysis and prognosis between older (³65 years) and younger patients. Methods Retrospective single-centre analysis of patients referred to the CR program (phase 1 and 2) between 2017 and 2024. Baseline characteristics, major adverse cardiovascular events (MACE) – a composite of death, non-fatal acute myocardial infarction (MI), cardiovascular rehospitalization and stroke -, quality of life (EuroQoL five-dimensional score), Hospital Anxiety and Depression Scale (HADS), exercise testing (ET) in METs (metabolic equivalents), International Physical Activity Questionnaire short-form (IPAQsf) (total physical activity METs-minutes/week), body mass index (BMI), abdominal circumference, lipid profile and hemoglobin A1c were compared. Results From a total of 307 patients, 69% were male and 28% were older than 65 years. Admission diagnoses consisted of ST-elevation MI (STEMI) (55%), non-ST-elevation MI (NSTEMI) (37%), unstable angina (2%), and other diagnosis in 6%. Dyslipidemia (78%), hypertension (59%), and smoking (45%) were the most common risk factors. There were no significant differences in admission diagnosis. Regarding past medical history, older patients had significantly higher rates of hypertension (p<0.001), diabetes (p=0.010), previous coronary heart disease (p=0.013) and cerebrovascular disease (p<0.001), while a history of smoking was significantly more common in younger patients (p<0.001). Dropout rate was 21% with no differences between groups (p=0.674). EuroQoL, HADS depression and IPAQsf scores showed no statistically significant differences between groups. Although functional capacity in ET was significantly worse in older patients at baseline and at the end of CR (p<0.001), PE improvements were similar between groups (p=0.321). Clinical evaluation (BMI, abdominal circumference) was similar between groups both at the beginning and the end of the program. Blood analysis had no relevant differences between groups. One-year MACE and follow-up (mean 2.5 years) MACE were observed in 2.6% and 6.2% of patients, respectively, with no significant differences between groups (p=0.211 and p=0.101). Conclusions Despite the differences in baseline characteristics and functional capacity, CR was equally beneficial in older patients in our population, with no significant differences in MACE. These findings suggest that age alone should not limit referral to cardiovascular rehabilitation programs. Nevertheless, tailored programs are of the utmost importance for the success of CR, particularly in older and frailer patients.