Cardiac Rehabilitation in Older Persons with Cardiovascular Disease
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ELDER AND HEART DISEASE (KUMAR DHARMARAJAN, SECTION EDITOR)
Cardiac Rehabilitation in Older Persons with Cardiovascular Disease David W. Goldstein 1 & Daniel E. Forman 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose of Review Despite widespread recommendations, cardiac rehabilitation (CR) is not well utilized in older adults. This review explores the valuable benefits of CR in geriatric patients as well as strategies to improve utilization. Recent Findings Eligibility for CR has long included coronary heart disease and has recently expanded to include heart failure, valvular disease, and peripheral artery disease, all which particularly impact older adults. New research has demonstrated unique functional and geriatric-specific benefits in older adults who participate in CR. Summary Though few studies have specifically focused on geriatric populations, these patients have similar benefits to CR in various types of cardiovascular disease in respect to improved morbidity, rehospitalization, and mortality. Furthermore, older adults participating in CR commonly derive unique benefits in respect to frailty, mood, and functional status. Nonetheless, utilization rates are low in the general population, and even lower in older adults. Increasing use of home-based programs may help increase utilization and benefits among older CR candidates. Keywords Cardiac rehabilitation . Geriatrics . Cardiovascular disease . Coronary heart disease
Introduction Cardiac rehabilitation (CR) is a multimodal intervention consisting of exercise therapy along with risk factor modification, education, and psychosocial support. While CR has been a standard part of cardiovascular management since the 1990s, its application is at a critical crossroads. Initially designed as a form of post-acute myocardial infarction (AMI) exercise training for middle-aged men in outpatient hospital-based programs, this model of CR has been typically expensive to run and poorly reimbursed. Moreover, its perceived value has been additionally eroded by advances in revascularization and medically stabilizing therapies that are often interpreted This article is part of the Topical Collection on Elder and Heart Disease * Daniel E. Forman [email protected] 1
Yale School of Medicine, New Haven, CT, USA
2
Section of Geriatric Cardiology, Divisions of Cardiology and Geriatrics, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15261, USA
3
Departments of Cardiology and the Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
as much more impactful than exercise and lifestyle modification. However, the perceived utility of CR has simultaneously expanded with greater insights about the value of exercise and wellness behaviors, new indications (e.g., valvular heart disease, heart failure [HF]), greater application to women, and greater outreach to a full spectrum of ages. Furthermore, CR has evolved into a much more extensive intervention than the exercise
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