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Cardiac Rehabilitation for Very Elderly Patients With Heart Failure: What Do We Know and Where Do We Need to Go?

      The number of patients with heart failure (HF) has increased with the global aging of the population. The majority of very elderly HF patients experience sarcopenia and frailty, both of which adversely affect prognosis. While there is accumulating evidence regarding the efficacy of cardiac rehabilitation (CR) for HF patients, the effectiveness of CR for frail, very elderly patients is unclear. The latest Asia-Pacific Clinical Practice Guideline for the Management of Frailty strongly recommended (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications (Dent et al, J Am Med Dir Assoc, 2017). The recent REHAB-HF pilot study, which was a multicenter cardiac rehabilitation intervention for frail elderly patients with HF, indicated that a tailored, progressive, multidomain CR intervention improved physical performance and reduced rehospitalization (Reeves et al, JACC Heart Fail, 2017). Importantly, changes in physical performance score (SPPB) explained 91% of the change in rehospitalization rate. These findings support a potential mechanistic link between physical function and rehospitalization in frail, older patients with HF. This session will review the evidence for CR in very elderly HF patients, and present ongoing work in this area.
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