Comparative Characteristics of Elderly and Middle-Aged Patients with Myocardial Infarction at the Third Stage of Cardiac Rehabilitation

Abstract

The need for adaptation of existing cardiac rehabilitation programs for elderly myocardial infarction patients is dictated both by the progressive aging of the Russian population and by the higher prevalence of cardiovascular diseases among them, including coronary heart disease in the form of a previous myocardial infarction. The necessary condition for successful realization of the set task is to take into account the identified features of myocardial infarction patients of older age group, who are admitted for cardiac rehabilitation. Aim. To give a comparative characteristic of patients with myocardial infarction of older and middle age groups admitting to the third stage of cardiac rehabilitation in the Ivanovo State Medical Academy clinic (ISMA). Material and methods. 85 patients with myocardial infarction were examined, they were admitted from primary vascular centers for a three-week course of cardiac rehabilitation at the ISMA clinic. According to the WHO age periodization, 2 groups were identified: 40 middle-aged patients (Group 1); 45 elderly patients (Group 2). An individual cardiac rehabilitation program was developed for each patient, which included daily controlled physical training, dosed walking, staircase walking at individually calculated pace, correction of the revealed cardiovascular risk factors, information support, adequate drug therapy, correction of psychological disorders if needed. Clinical features of the disease course, tolerance to physical activity were analyzed in both groups. Results. The characteristic features of MI patients of the older age group in comparison with the middle-aged patients admitted to the third stage of cardiac rehabilitation in the ISMA clinic are: dominance of non-working pensioners; high polymorbidity; higher frequency of development of repeated MI without ST-segment elevation on ECG; predominance of complicated formation of left ventricular aneurysms and heart rhythm disturbances forms of MI; low frequency coronary revascularization in the acute period of the course of the disease; prevalence of persons with signs of diastolic heart failure with preserved or slightly reduced left ventricular ejection fraction; lower exercise tolerance. After completion of cardiac rehabilitation course in patients of older age group the increase in 6MWT distance covered was 18%, while in middle-aged group it was only 8.3%. The implementation of the three–week rehabilitation program led to an increase in the number of patients with 1 FC of coronary heart disease due to a decrease in the number of patients with 3 and 4 FC of coronary heart disease in the middle-aged group and 4 FC of coronary heart disease in the elderly. Conclusion. The identified features specify the necessity to include methods of concomitant pathology correction, individual approach to the choice of physical activity programs based on a thorough clinical assessment, including risk stratification of post-rehabilitation complications and rehospitalizations in the cardiac rehabilitation program. A three-week program of the third stage of cardiac rehabilitation of MI patients increases exercise tolerance to a greater extent in elderly patients compared with middle-aged patients.