Department of Internal Medicine, Massachusetts General Hospital, Boston (Dr Goldstein); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Drs Hajduk, Krumholz, and Chaudhry and Mss Tsang and Geda); Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut (Ms Song); Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York (Dr Dodson); Geriatric Cardiology Section, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Forman), and Section of Health Policy and Management, Yale School of Public Health, New Haven, and Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut (Dr Krumholz).
J Cardiopulm Rehabil Prev. 2022 Mar 1;42(2):109-114. doi: 10.1097/HCR.0000000000000627.
Cardiac rehabilitation (CR) is a key aspect of secondary prevention following acute myocardial infarction (AMI). While there is growing evidence of unique benefits of CR in older adults, it remains underutilized. We aimed to examine specific demographic, clinical, and functional factors associated with utilization of CR among older adults hospitalized with AMI.
Our project used data from the SILVER-AMI study, a nationwide prospective cohort study of patients age ≥75 yr hospitalized with AMI and followed them up for 6 mo after discharge. Extensive baseline data were collected on demographics, clinical and psychosocial factors, and functional and sensory impairments. The utilization of CR was collected by a survey at 6 mo. Backward selection was employed in a multivariable-adjusted logistic regression model to identify independent predictors of CR use.
Of the 2003 participants included in this analysis, 779 (39%) reported participating in CR within 6 mo of discharge. Older age, longer length of hospitalization, having ≤12 yr of education, visual impairment, cognitive impairment, and living alone were associated with decreased likelihood of CR participation; receipt of diagnostic and interventional procedures (ie, cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft) was associated with increased likelihood of CR participation.
Demographic and clinical factors, as well as select functional and sensory impairments common in aging, were associated with CR participation at 6 mo post-discharge in older AMI patients. These results highlight opportunities to increase CR usage among older adults and identify those at risk for not participating.
心脏康复（CR）是急性心肌梗死（AMI）后二级预防的关键方面。虽然越来越多的证据表明 CR 对老年人有独特的益处，但它的利用率仍然很低。我们旨在研究与老年人因 AMI 住院后接受 CR 相关的特定人口统计学、临床和功能因素。
我们的项目使用了 SILVER-AMI 研究的数据，这是一项针对年龄≥75 岁的 AMI 住院患者的全国前瞻性队列研究，并在出院后对他们进行了 6 个月的随访。在基线收集了大量关于人口统计学、临床和心理社会因素以及功能和感觉障碍的数据。在 6 个月时通过调查收集 CR 的使用情况。采用多变量调整逻辑回归模型进行向后选择，以确定 CR 使用的独立预测因素。
在本分析中纳入的 2003 名参与者中，有 779 名（39%）报告在出院后 6 个月内参加了 CR。年龄较大、住院时间较长、受教育程度≤12 年、视力障碍、认知障碍和独居与 CR 参与的可能性降低相关；接受诊断和介入程序（即心脏导管插入术、经皮冠状动脉介入治疗和冠状动脉旁路移植术）与 CR 参与的可能性增加相关。
在年龄较大的 AMI 患者中，人口统计学和临床因素以及衰老时常见的某些功能和感觉障碍与出院后 6 个月的 CR 参与相关。这些结果强调了增加老年人 CR 使用的机会，并确定了那些不参与的风险人群。
