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American College of Cardiology 2021

Contributor: Kseniia Eruslanova

Origin/Afiliations: Russian clinical and research geriatric center

ESC congress, a small section, how to handle older patients with syncope. And small debate inside of it: why cardiologists should pay attention to age? One of the opinions was: We have clear guidelines. We have RCT (it does not matter that older adults predominately were excluded from them mostly). As cardiologists, we do not need to know/understand the geriatric status. We handle our problem.

Even the side that supports that older adults need a distinct approach looks at the problem from the position that age matters, rather than the patient status: frailty, comorbidity, etc.

Two years later, one of the most considerable studies on ACC is about handling frail older adults with heart failure: REHA-HF.

Assessment of the effectiveness and safety of rehabilitation programs in elderly patients hospitalized due to CHF decompensation: 349 patients (175 active group and 174 - control group), follow-up period three months, average age 73 years, 52% women). The rehabilitation program included exercises three times a week (first in the center, then at home); the program was selected considering the age and concomitant frailty. Results. Primary end-point: Improvement in performance in the short battery of physical performance (8.3 vs. 6.9 controls, p <0.001). Secondary points: increased 6-minute walking distance (293 vs. 260 (p = 0.007)), increased walking speed (0.8 vs. 0.68 (p <0.05)), higher scores on the Kansas City Cardiomyopathy Questionnaire (69 vs. 62 (p = 0.007)). However, the rehabilitation program did not affect the readmission rate and mortality in these patients. However, it improves functional status.

And nowadays, nobody can say that the functional status of patients does not matter for cardiologists.

(Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O'Connor CM. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med. 2021 May 16. doi: 10.1056/NEJMoa2026141. Epub ahead of print. PMID: 33999544.)

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