Cardiac rehabilitation in older adults: is it just lifestyle?

It is well established that there are patients who are less likely to access cardiac rehabilitation (CR). They include women, those of low socioeconomic status, patients living in rural areas, ethnocultural minorities and older adults. Reflecting on Jepma et al ’s paper in Heart ,1 we turn our focus to CR programmes for older adults. Despite CR being a class I recommendation in the European Society of Cardiology guidelines,2 there continues to be a significant underutilisation of CR in older adults. Knowledge gaps across current evidence-based practice guidelines pertain to lack of sufficient data to provide sound recommendations for older adults. This is in part due to the fact that studies on which guidelines are based enrolled a low number of older adults or included older adults with few comorbidities.3 ### Effect of CR in older adults In their paper in Heart , Jepma et al 1 investigated the effect of nurse-coordinated referral to a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (the RESPONSE-2 trial). The trial included 824 patients from 15 centres in the Netherlands. The primary outcome was the proportion of patients with improvement at 12-month follow-up in one or more lifestyle risk factors. Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving lifestyle risk factors in older as in younger patients. Adherence in older adults was excellent, with over 87% completing the physical activity programme. In fact, older adults attended significantly more weight reduction sessions and over 71% completed the smoking cessation programme. The effect of CR in older adults is not new.4 However, it has not reached to the forefront of …