Effect of outpatient cardiac rehabilitation program on outcome of elderly patients, especially in frailty status

Abstract

Cardiac rehabilitation improves exercise-tolerance, QOL, reduces the risk of cardiovascular event and improves the prognosis. Frailty is the risk of hospital admission, and worsen prognosis. Retrospective observational cohort study. Patients hospitalized with cardiovascular disease from January 2015 to March 2016. Study patients were matched for two groups who kept rehabilitation after discharge and who did not, with follow-up until December 2016. Propensity analyses were used. The endpoint was death from any cause, cardiac death, hospitalization for heart failure, ACS, ER visit, TVR, and emergency admission for any cause. Analysis about the factor reduced the adverse event was done. In 2258 patients admitted, 104 got into the outpatient cardiac rehabilitation. Out of 554 study patients, 47 underwent rehabilitation. The frequency of emergency hospitalization tends to be few in rehabilitation group ( P = 0.067). Especially in elderly over 65, rehabilitation reduced the risk of emergency admission (2.8% vs. 16.3%; P = 0.031). After propensity score matching, emergency hospitalization was few in rehabilitation group ( P = 0.088). In rehabilitation group, CHS index significantly improved ( P < 0.001). Significant reduction of the emergency admission was shown ( P < 0.001). Frailty status was assessed in 31, 8 fell under the category of frailty. Through rehabilitation, 6 pulled out of category. Out of 23 patients whose score more than zero, 13 improved their score. Between the two groups in that emergency admission reduced, and in that did not, following data result are significantly different, LVEF, creatinine, uric acid, total protein, BNP level at start, and the amount of hemoglobin change during hospitalization. Age, gender, BMI, and CHS index at start, did not show a significant difference. In elderly, improvement of frailty certainly contribute to avoiding emergency hospitalization. Outpatient Cardiac rehabilitation reduces the risk of emergency hospital admission, especially in elderly people. Improvement of Frailty is one of the most important factors.