Effects of Cardiac Rehabilitation on Cardiovascular Events in Elderly Patients with Stable Coronary Artery Disease

Abstract

The elderly population has rapidly grown in Japan, resulting in a remarkable increase of patients with coronary artery disease (CAD). The elderly people have a higher incidence of acute myocardial infarction in comparison with younger population. Cardiac rehabilitation (CR) has numerous benefits including reduction of mortality and cardiovascular events in patients with CAD. Because of these high rates of morbidity and mortality, primary and secondary prevention programs are important strategies not only for modifying cardiovascular risk factors, but also for improving mortality and quality of life. However, the long-term effect of phase III CR in elderly patients with stable CAD is still unknown. PURPOSE: To assess the effects of phase III comprehensive CR on mobility and mortality of cardiovascular diseases in elderly male Japanese patients with CAD. METHODS: We analyzed 111 elderly male CAD patients (≥65 years) including 37 subjects participating in the supervised CR during six months and 74 age-matched controls. We followed the patients for up to 3,500 days, until the occurrence of death and one of the following major adverse cardiovascular events (MACE): cardiovascular death, acute coronary syndrome (ACS), refractory angina requiring revascularization, admission for congestive heart failure (CHF), and stroke. RESULTS: All cause mortality tended to be lower in the CR group than in the control group (14 vs. 28%, P=0.081). The MACE incidence was significantly lower in the CR group than in the control group (30% vs. 62%, P=0.001). The other incidences of cardiovascular death, ACS, refractory ischemia requiring percutaneous coronary intervention or coronary artery bypass grafting, admission for CHF, stroke, and cancer were not significantly different between the two groups. Kaplan Meier analysis demonstrated that the CR group had a significantly lower rate of MACE, but not all-cause death, during the entire follow-up period (P=0.007, P=0.194, respectively). Multivariate Cox proportional hazard analysis showed that the MACE incidence was significantly lower in the CR group than in the control group [adjusted hazard ratio 0.43 (95% CI 0.20-0.91), P=0.027]. CONCLUSIONS: Phase III CR has beneficial effects for reduction of cardiovascular events even in elderly patients with stable CAD.