Walter Bierbauer1,2, Urte Scholz1,2,3, Tania Bermudez1,2, Dries Debeer4, Michael Coch5, Ruth Fleisch-Silvestri6, Claude-Alain Nacht7, Hansueli Tschanz8, Jean-Paul Schmid9, Matthias Hermann10,11. 1. Department of Psychology, University of Zurich, Switzerland. 2. University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Switzerland. 3. Center of Competence Multimorbidity, University of Zurich, Switzerland. 4. Department of Psychology, Psychological Methods, Evaluation and Statistics, University of Zurich, Switzerland. 5. Department of Cardiology, Reha Seewis, Switzerland. 6. Clinic Schloss Mammern, Switzerland. 7. Department of Cardiology, Clinic La Lignière, Switzerland. 8. Department of Cardiology, Berner Reha Zentrum, Switzerland. 9. Department of Cardiology, Clinic Barmelweid, Switzerland. 10. Zürcher RehaZentrum Wald, Switzerland. 11. University Heart Center, University Hospital Zurich, Switzerland.
Abstract
AIMS: Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. METHOD: A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. RESULTS: Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen's d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. CONCLUSION: As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients' age and sex.
AIMS: Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. METHOD: A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. RESULTS: Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen's d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. CONCLUSION: As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients' age and sex.
Keywords:
Six-minute walk test; in-patient rehabilitation; older patients; random forest; women
Authors: Lena Jellestad; Vera G Meier; Walter Bierbauer; Tania Bermudez; Bianca Auschra; Moritz P Günther; Urte Scholz; Roland von Känel; Matthias Hermann; Sebastian Euler Journal: Qual Life Res Date: 2022-10-11 Impact factor: 3.440