Early Mobilization in Older Adults with Acute Cardiovascular Disease

Abstract

Background Early mobilization (EM) is beneficial in critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods Consecutive admissions of adults ≥80 years old to a Cardiac Intensive Care Unit (CICU) prior to and following implementation of a nurse-driven EM program were reviewed. Mobility was measured using the Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 meters). The primary outcome was discharge home. Results There were 412 patients included (N = 234, intervention; N = 178, preintervention). There was no difference in age between groups (overall 86.3 ± 4.8 years old) or sex (overall female N = 215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prehospitalization and in 209 patients (89.3%) on admission. Nearly half of patients (N = 107; 45.7%) improved their LOF by ≥1 during admission. Mobilization occurred during nearly all opportunities (838/850; 98.6%), and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2% adverse event rate]) and transient. Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4 vs. 65.7%, P = 0.047, respectively) and had a lower rate of in-hospital death (6.4 vs. 14.6%, P = 0.006, respectively). There was no difference in mean length of hospital stay, 30-day emergency department visit or hospital re-admission. Conclusion EM is safe in older adults in the CICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

“…Recently, the safety and efficacy of an early intervention in older patients with cardiovascular diseases, including HF, have been reported. A previous study of 412 older patients with cardiovascular disease (mean age, 86.3 years) revealed that early mobilization was safe and associated with reduced discharge to a healthcare facility and in‐hospital mortality among older patients admitted to the cardiac intensive care unit 29 . A previous study of 264 older patients admitted to the cardiovascular intensive care unit (mean age, 77.1 years) reported that early mobilization could be performed without patient falls, catheter or vascular line dislodgements, or healthcare personnel injuries 30 .…”

“…A previous study of 412 older patients with cardiovascular disease (mean age, 86.3 years) revealed that early mobilization was safe and associated with reduced discharge to a healthcare facility and in-hospital mortality among older patients admitted to the cardiac intensive care unit. 29 A previous study of 264 older patients admitted to the cardiovascular intensive care unit (mean age, 77.1 years) reported that early mobilization could be performed without patient falls, F I G U R E 2 Acute-phase initiation of rehabilitation for the in-hospital mortality in each subgroup in the propensity score-matched cohort. Body mass index was classified into two groups by median (median value = 20 kg/m 2 ).…”

Sedentary Time in Older Adults With Acute Cardiovascular Disease

“… 21 EM has also been shown to be safe, feasible, and effective in older adults with acute cardiovascular disease. 22 In addition to reducing in hospital sedentary time, EM may also improve mood and cognitive outcomes as well as reduce the functional decline associated with posthospitalization syndrome. 23 However, the bulk of the current evidence base for mobility programs is for mechanically ventilated patients in critical care units.…”