Cardiac rehabilitation for old-old patients with heart failure and severe functional impairment

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The effects of cardiac rehabilitation (CR) in old patients with heart failure (HF) and severe functional impairment (SFI) are not well established. We studied 1397 patients with HF and severe functional impairment, defined as a six-minute walking distance (6MWD) <300m, admitted to inpatient CR. The patients were divided into three groups: Group A (young, ≤65years), Group B (old-young, 66 to 75years), and Group C (old-old, >75years). The primary outcome was an increase in 6MWD to 300m or more after CR. We used multivariable Cox modeling to determine the association of the primary outcome with three-year mortality after discharge from CR. At admission to CR, 38.5% of the patients in group A, 40.0% in group B, and 46.3% in group C (p=.029) were unable to walk unassisted. Of these patients, 29.5%, 32.6%, and 30.2% (p=.835), respectively, regained the ability to walk independently. Overall, 370 (26.5%) patients achieved the primary outcome, 49.1% in group A, 32.2% in group B, and 15.7% in group C (p<.001). The adjusted HR of 3-year mortality for the patients who achieved the primary outcome was 0.53 (95%CI 0.34-0.83; p=.005) in group A, 0.49 (95%CI 0.33-0.74; p=.001) in group B, and 0.68 (95%CI 0.47-0.98; p=.037) in group C. Our findings suggest that old-old patients with HF and severe functional impairment may benefit from CR and that functional improvement may predict improved survival.