Cardiac Rehabilitation for Older Adults: Vital Opportunity to Improve Patient-Centered Cardiovascular Disease Care amid Worldwide Patient Aging

Abstract

Cardiac rehabilitation (CR) has particular value for contemporary patients with cardiovascular disease (CVD) as it provides a unique opportunity to evaluate and address the distinctive needs of adults who are, on average, much older and complex than patients of years past. People are living longer in the United States and in much of the world, and aging is the number 1 risk factor for CVD as well as to its presentation in a context of multimorbidity, frailty, polypharmacy, and other geriatric complexities of care (also commonly including cognitive decline, sensory impairments, and increased falls). Thus, even if their incident CVD is treated flawlessly, older CVD patients are more susceptible to death as well as to high morbidity, functional decline, and worse quality of life. Approaches to CVD oriented exclusively to traditional disease management precepts of procedures and medications are rarely sufficient for older patients as their efficacy is often less reliable amid confounding geriatric intricacies. Overall, non-CVD factors become relatively more determinant of outcomes and patient-perceived value of care. CR affords opportunities for broader assessments and novel approaches that address such challenges and which can also monitor recovery over time. This special issue of the Clinics in Geriatric Medicine provides an expansive overview of pertinent perspectives. Articles by O’Neill and colleagues and Fiatarone Singh provide orientation to the geriatric domains impacting older CVD patients. Afilalo focuses particularly on frailty, and articles by Khadanga and colleagues, Dun and colleagues, Redfern, and Beckie focus more specifically on distinctive approaches in CR with resistance training, high-intensity interval training, smart devices and wearables, and home-based strategies, respectively. Similarly, Flint and colleagues, Thomas and colleagues, and Tarro Genta and colleagues focus on CR for older adults in respect to its application to diseases/procedures that are most likely to occur in adults who are older, including heart failure, peripheral arterial disease, and transcatheter aortic valve replacement. Subsequent articles focus on novel applications of CR: Goyal and colleagues describe a novel strategy to expand CR to also deprescribe pills from older patients with heart failure who may be overmedicated, Podlogar and colleagues describe the value of CR in postacute care, and Boreskie and colleagues describe utility of prehabilitation in older adults before CVD procedures. Finally, Yoo and colleagues focus on pertinent sex-related issues in CR as women outlive men and benefit from approaches that address sex-related underpinnings to CVD and non-CVD in older patients. This collection from authors throughout the world showcases the value of CR as a way to improve care amid health care challenges that are very distinctive for older populations. The articles do not promote CR as it has been, but rather they highlight the potential to expand and enrich CR to address contemporary needs. We hope many readers will be inspired to champion efforts that advance this approach for their own communities and patients.