Long-term functional outcomes after cardiac rehabilitation in older patients

Cardiac rehabilitation has proven to be effective in reducing mortality and morbidity, and in improving functional capacity, risk profile and quality of life (QoL) after acute cardiac events in the general cardiac population.1 Although the elderly are not often referred to cardiac rehabilitation due to a number of clinical, social or cultural barriers,2,3 cardiac rehabilitation has proven to be effective also in the elderly, leading to important improvement in functional capacity, coronary risk factors, symptoms, QoL and psychosocial status.4,5 However, many of these improvements fade in the medium to long term if the discharge recommendations, particularly those directed at maintaining physical activity and some form of exercise training, are not followed.6 Therefore, many strategies have been proposed in order to maintain these improvements in the medium–long term. In this number of the Journal of Preventive Cardiology, Pratesi et al.7 reported a very interesting trial focusing on long term results of cardiac rehabilitation in the elderly. In this study 160 elderly patients over 75 years, with relatively good physical capacity, no disabilities or severe comorbidity, after the completion of a four-week outpatient cardiac rehabilitation were randomized to a treatment group based on a structured home exercise programme, closely followed with exercise diary and monthly in-hospital reinforcement, and to a control group who received only general recommendation to exercise at home. Functional capacity, muscular function and QoL improved at the end of four-week cardiac rehabilitation in both groups, and these improvements were maintained at six and 12 months both in patients following the home programme and in control patients assigned to routine care. Therefore this study confirms that cardiac rehabilitation in the elderly over 75 years of age is feasible with good functional results, but more importantly shows that the improvements reached at the end of cardiac rehabilitation stand well the test of time, at least one year after the completion of cardiac rehabilitation, even with generic recommendations, and that a home-based exercise programme does not provide additional improvement nor add any long-term functional benefit beyond that of a routine four-week cardiac rehabilitation programme.