Improvement needed in at-home cardiac care for elderly

By Sarah Guy, medwireNews Reporter

Elderly patients with coronary heart disease who refuse an offer of center-based cardiac rehabilitation (CR) and receive an at-home plan instead fare no better after 12 months than their counterparts who receive usual care, report researchers.

While home-based CR resulted in a significant increase in distance in the 6-minute walk test after 3 months compared with usual care, there was a decline in test results by 12 months in both groups.

Furthermore, when data were adjusted for potentially confounding factors, there was no significant difference between groups in the walking test at 3 months.

"The discrepancy could be caused by the duration of our home intervention that may have been too short to maintain changes at 12 months' follow up," write Bodil Oerkild (University Hospital, Copenhagen, Denmark) and colleagues in BMJ Open.

The team randomly assigned 40 individuals aged at least 65 years with coronary heart disease, including myocardial infarction and coronary artery bypass graft, to receive either home-based care (n=19) or usual care (n=21).

The home-based program comprised two visits by a physiotherapist over a 6-week interval to create a daily 30-minute exercise program that could be performed at home or in local surroundings, as well as a risk factor intervention and medical adjustment by a cardiologist at baseline and after 3, 6, and 12 months. Usual care included only the risk factor intervention and medical adjustment.

Unadjusted data show that by the 12-month follow up, home-care participants had a significant 33.5 m increase in distance during the 6-minute walking test, while their counterparts in the usual care group had a nonsignificant increase of 10.1 m.

However, after adjusting the results for age and gender, these significant between-group differences were lost, and a significant decrease in ability at the 6-minute walking test was evident in both groups.

By 12 months, Oerkild and colleagues observed a higher proportion of patients from the home-care group had changed from an inactive to an active lifestyle, at 27% versus a decrease of 5% in the usual care group.

"This study could contribute to the scientific gap on how to manage the large population of elderly cardiac patients who are not interested in (or capable of) participating in a centre-based CR programme," concludes the team.

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