Cardiac Rehabilitation in the Elderly Patients

Abstract

Cardiac rehabilitation for elderly patient is a growing need because as people age the prevalence of cardiovascular disease increases. A more vulnerable population is now present in cardiac rehabilitation because they are more likely to be frail. Frailty, a core geriatric concept, is considered highly prevalent in geriatric population and heterogeneous in its level of expression. Following hospitalization for a coronary event such as an acute coronary syndrome or heart failure decompensation, all patients, and in particular the elderly, are at increased risk of instability, new cardiovascular event, and disability. The efficacy and safety of cardiac rehabilitation have been widely demonstrated also in the elderly patients with stable coronary heart disease treated medically or those who have undergone myocardial revascularization with percutaneous coronary intervention, coronary artery bypass graft surgery, and heart failure. Cardiac rehabilitation programs are designed to enhance recovery from acute cardiovascular events and to improve both quality of life and survival by means of measure of secondary prevention—physical activity, diet, risk factor control, and medical treatment optimization. Accumulating evidence has shown comparable exercise training benefits in older and younger patients. The use of cardiac rehabilitation programs in the elderly should be based on comprehensive geriatric assessment in which different domains need to be reviewed with a definite rehabilitation program driven by the specific disability and not only related to the disease. Special attention should be posed to frail elderly patients in whom a personalized intervention is necessary. Rehabilitation protocols for elderly based on prevalent disability status will be described in details.