Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial.

OBJECTIVE: To compare home-based cardiac rehabilitation (CR) with usual care (control group with no rehabilitation) in elderly patients who declined participation in centre-based CR. DESIGN: Randomised clinical trial with 12 months follow-up and mortality data after 5.5 years (mean follow-up 4½ years). SETTING: Rehabilitation unit, Department of Cardiology, Copenhagen, Denmark. PARTICIPANTS: Elderly patients ≥65 years with coronary heart disease. INTERVENTION: A physiotherapist made home visits in order to develop an individualised exercise programme that could be performed at home and surrounding outdoor area. Risk factor intervention, medical adjustment, physical and psychological assessments were offered at baseline and after 3, 6 and 12 months. MAIN OUTCOME MEASUREMENTS: The primary outcome was 6 min walk test (6MWT). Secondary outcomes were blood pressure, body composition, cholesterol profile, cessation of smoking, health-related quality of life (HRQoL), anxiety and depression. RESULTS: 40 patients participated. The study population was characterised by high age (median age 77 years, range 65-92 years) and high level of comorbidity. Patients receiving home-based CR had a significant increase in the primary outcome 6MWT of 33.5 m (95% CI: 6.2 to 60.8, p=0.02) at 3 months, whereas the usual care group did not significantly improve, but with no significant differences between the groups. At 12 months follow-up, there was a decline in 6MWT in both groups; -55.2 m (95% CI: 18.7 to 91.7, p<0.01) in the home group and -52.1 m (95% CI: -3.0 to 107.1, p=0.06) in the usual care group. There were no significant differences in blood pressure, body composition, cholesterol profile, cessation of smoking or HRQoL after 3, 6 and 12 months follow-up. CONCLUSIONS: Participation in home-based CR improved exercise capacity among elderly patients with coronary heart disease, but there was no significant difference between the home intervention and the control group. In addition, no significant difference was found in the secondary outcomes. When intervention ceased, the initial increase in exercise capacity was rapidly lost.

Self-reported physical inactivity predicts survival after hospitalization for heart disease.

Physical inactivity increases with age and is shown to be inverse and independently related to mortality among patients with coronary heart disease. However, the knowledge of this relationship among elderly heart patients is limited because of their exclusion from many studies. The aim of this study was to investigate how self-reported physical activity affects all-cause mortality among elderly patients admitted to hospital with coronary heart disease or congestive heart failure. An observational study was carried out, including patients ≥65 years of age who were admitted to a Coronary Unit with coronary heart disease or congestive heart failure. Patients were asked to fill in a questionnaire on physical activity and divided into a sedentary and non-sedentary group, and followed for vital status for 2 ¹/2; years after admission. In total, 150 patients participated. Within this study, all-cause mortality was 27.3%. Sedentary patients had a 3.9-fold (95% CI, 1.9 to 7.8) increase in mortality compared to non-sedentary patients. Adjusting for potential confounders such as severity of heart disease, co-morbidity, medication and social factors in a Cox proportional hazard regression model did not attenuate the association. Only 25% of sedentary patients with heart failure were alive after 2 ¹/2; years compared to 75% of those that were physically active (p < 0.001). This study emphasises the importance of physical activity among elderly heart patients and demonstrates that a group of sedentary patients, who are at high risk, can easily be identified and require special attention.

Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.

BACKGROUND: participation in centre-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality but participation rates among the elderly are low. Establishing alternative programmes is important, and home-based CR is the predominant alternative. However, no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up. METHODS: randomised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease. RESULTS: seventy-five patients participated. There were no significant differences in exercise capacity after the intervention between home and centre-based CR. Adjusted mean differences of peak VO2 = 0.9 ml/kg/min (95% CI -0.7, 2.4) and of 6 min walk test = -18.7 m (95% CI -56.4, 18.9). In addition, no differences were found in the secondary outcomes of systolic blood pressure (-0.6 mmHg, 95% CI -11.3, 10.0), LDL cholesterol (0.3 mmol/l, 95% CI -0.04, 0.7), HDL cholesterol (0.2 mmol/l, 95% CI -0.01, 0.3), body composition, proportion of smokers and health-related quality of life. A group of patients who did not have an effect of either programmes were characterised by higher age, living alone and having COPD. At 12 months of follow-up, both groups had a significant decline in exercise capacity. CONCLUSIONS: home-based CR is as effective as centre-based CR in improving exercise capacity, risk factor control and health-related quality of life. However, a group of patients did not improve regardless of the type of intervention. Continued follow-up is essential in order to maintain the gained improvements.