[Elderly patient-centered rehabilitation after cardiac surgery]. / Percorso riabilitativo individualizzato dedicato al paziente ultrasettantenne cardioperato.

The rate of over-70 year post-surgery patients referred to the Cardiac Rehabilitation Units is increasing. Strategies designed to encourage and facilitate participation in rehabilitation programs in the elderly should be developed. Aim of this paper is to present our elderly-centered program, specifically designed on patient's needs and frailty, and its short- and medium-term results in 160 consecutive over-70 year patients, admitted in our Cardiac Rehabilitation Unit soon after cardiac surgery. The program was safe, well accepted by the patients, and effective in improving objective and subjective functional status.

[A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery]. / Un nuovo test (VITTORIO Test) per la valutazione dell'efficienza fisica in soggetti ammessi a programmi di riabilitazione dopo intervento di chirurgia cardiaca.

An adequate assessment of physical function (PF) in Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients' ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7 +/- 6.3 days after cardiac surgery) and a final test (T2) after an in-hospital intensive training program (mean length 16.8 +/- 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs.

[Distance covered in walking test after heart surgery in patients over 70 years of age: outcome indicator for the assessment of quality of care in intensive rehabilitation]. / La distanza percorsa al test del cammino dopo chirurgia cardiaca in pazienti ultrasettantenni: un indicatore di risultato per la valutazione della qualità delle cure in riabilitazione intensiva.

UNLABELLED: For quality-of-care assessment of rehabilitation programs after cardiac surgery, measures of functional recovery have been proposed as outcome indicators. Aim of this study was to evaluate the feasibility, the safety and the informative content of the 6-min walking test (6 WT) performed in elderly patients soon after admission in an intensive rehabilitation program after cardiac surgery. METHODS: Population consists of 115 consecutive over-70 patients admitted to an in-hospital rehabilitation program after cardiac surgery. Within 7 days of admission, in 107 patients (93%) clinical conditions allowed the execution of a 6 WT, on ECG telemetry monitoring. Resting and exertional heart rate, score of fatigue (Borg Scale 1 divided by 20), symptoms, ECG alterations and arrhythmias were recorded. Other considered variables were: comorbidity (Charlson index), length of stay and complications occurring during the whole surgical and rehabilitation in-hospitalisation stay, disability (nursing needs: Maslow and nursing chart), functional status at discharge, left ventricular ejection fraction, number of exercise treatment sessions, self-perceived health-status at admission and at discharge (EuroQoL questionnaire). RESULTS: The mean walked distance was 194 +/- 93 m. No complication neither ECG alteration occurred during the 6 WT; only isolated premature ventricular beats were recorded in 26 pts. Heart rate increased from 86 +/- 13 at rest to 95 +/- 17 bpm at the end of the 6 WT (p < .0001). The perceived fatigue score was 12.9 +/- 1.2 Borg. Complications, length of stay, nursing needs, self-perceived health-status and functional capacity at discharge differed between patients who performed the 6 WT within 4 days compared with those who did it later, and between patients who walked < or = 120 m (lower quartile) compared with those who walked more. CONCLUSIONS: In elderly patients after cardiac surgery the 6 WT performed within the first week of admission in rehabilitation unit is feasible and safe. Simple cut-offs like timing of the 6 WT and walking performance identify more severe patients with lower susceptibility to recovery.