Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Schopfer, David W.; Forman, Daniel E.

doi:10.1016/j.cardfail.2016.10.010

Cited by 30 publications

(39 citation statements)

References 90 publications

(86 reference statements)

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“…16–18 Since CR has traditionally been for patients with IHD and cardiac surgery, patients with HF are less likely to be prescribed CR. Many misconceptions of the potential harm of exercise causing ventricular remodeling hindered the CR referral.…”

Section: Discussionmentioning

confidence: 99%

“…Many misconceptions of the potential harm of exercise causing ventricular remodeling hindered the CR referral. 18 Access to transportation and geographic distance to CR programs is a major barrier as nearly 24% of VA enrollees are from rural areas 19 and 76% of VA enrolled Veterans live over one hour from a VA CR center. Also, only stable patients with HFrEF are currently considered eligible for CR.…”

Section: Discussionmentioning

confidence: 99%

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Participation in Cardiac Rehabilitation Among Patients With Heart Failure

Park

Schopfer

Zhang

et al. 2017

Journal of Cardiac Failure

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Objectives We sought to determine: a) the proportion of patients with heart failure (HF) who participated in cardiac rehabilitation (CR); and b) patient characteristics associated with participation. Background CR is linked to reduced mortality and morbidity including improvements in cardiorespiratory fitness, psychosocial state, and quality of life in patients with HF. However, little is known about CR utilization among patients with HF. Methods A retrospective study was conducted using national data from the Centers for Medicare & Medicaid Services and the Veterans Health Administration (VA). We used primary discharge ICD-9 codes to identify patients hospitalized for HF from 2007–2011 then identified CR participation using CPT codes from claims data. Multivariate logistic regression was used to identify patient characteristics associated with CR participation. Results There were 66,710 Veterans and 243,208 Medicare beneficiaries hospitalized for HF and 1,554 (2.3%) and 6,280 (2.6%), respectively, who attended one or more sessions of outpatient CR. Among Medicare beneficiaries, men were more likely than women to participate in CR (3.7% vs. 1.8%; p<0.001), but there was no gender difference among Veterans (2.3% vs. 2.8%; p=0.40). Characteristics associated with participation in CR among both groups included younger age, white race, and history of ischemic heart disease. Conclusions Very few HF patients participated in CR with lower rates among those who were older, non-white, and female with a history of depression or other chronic medical conditions. Since Medicare has recently introduced coverage for CR in patients with systolic HF, we must increase efforts to improve CR participation, especially among these vulnerable groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Participation in Cardiac Rehabilitation Among Patients With Heart Failure

Park

Schopfer

Zhang

et al. 2017

Journal of Cardiac Failure

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“…52,53 Functional improvements achieved in CR have also been demonstrated to enable older adults to perform activities of daily living at a lower percentage of overall CRF such that efficiency and confidence are improved. 6 As it is now wellknown that adults with CVD are more likely to attend CR when healthcare providers make the recommendation in person, 54 communication regarding the importance of CR (and activity in general) is an essential part of optimal care.…”

Section: Improving Functional Capacitymentioning

confidence: 99%

“…Older adults are not only inherently prone to CVD events, but to functional declines resulting from CVD as well as idiosyncratic age‐related vulnerabilities that typically arise as part of CVD in old age. Most older adults develop multiple CVDs simultaneously (eg, coronary artery disease in combination with heart failure and valve disease) as well as non‐CVDs (eg, chronic kidney disease, diabetes, and chronic obstructive pulmonary disease) and geriatric syndromes (eg, polypharmacy and frailty) that are conducive to compounding tendencies towards sedentariness, poor quality of life, frailty, disability, and dependency . Acute disease then exacerbates the problem with hospitalization‐related deconditioning, malnutrition, sedation, and even due to many of the therapies that are utilized (eg, beta blockers).…”

Section: Introductionmentioning

confidence: 99%

“…Most older adults develop multiple CVDs simultaneously (eg, coronary artery disease in combination with heart failure and valve disease) as well as non-CVDs (eg, chronic kidney disease, diabetes, and chronic obstructive pulmonary disease) and geriatric syndromes (eg, polypharmacy and frailty) that are conducive to compounding tendencies towards sedentariness, poor quality of life, frailty, disability, and dependency. [5][6][7][8] Acute disease then exacerbates the problem with hospitalization-related deconditioning, malnutrition, sedation, and even due to many of the therapies that are utilized (eg, beta blockers). Goals to improve functional outcomes are both important as a patient's priority of care, but also as a public health mandate in a population otherwise prone to disability and high cost of care.…”

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confidence: 99%

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The importance of physical function as a clinical outcome: Assessment and enhancement

Oneill

Forman

2019

Clinical Cardiology

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The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide‐ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.

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Frailty and heart failure: State‐of‐the‐art review

Talha,

Pandey,

Fudim

et al. 2023

J cachexia sarcopenia muscle

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At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30–60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF‐specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5‐fold to 2‐fold higher risk of all‐cause death and hospitalizations compared to non‐frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non‐frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline‐directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry‐based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline‐based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.

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Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

Cited by 30 publications

References 90 publications

Participation in Cardiac Rehabilitation Among Patients With Heart Failure

Participation in Cardiac Rehabilitation Among Patients With Heart Failure

The importance of physical function as a clinical outcome: Assessment and enhancement

Frailty and heart failure: State‐of‐the‐art review

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