Reabilitação cardiovascular domiciliar para paciente idoso frágil após evento cardíaco agudo

Abstract

Introduction: The aging population and the high prevalence of cardiovascular diseases demand preventive actions at all levels of healthcare. Cardiac rehabilitation is essential for improving the physical and psychological well-being of patients with these conditions, with home-based modalities standing out for their accessibility and equity. Objectives: This study aimed to investigate whether a Home-based Cardiovascular Rehabilitation (HBCR) program, initiated shortly after acute cardiac events, could reduce the primary composite outcome of death and hospitalization due to heart failure or acute coronary syndrome. Secondary outcomes included evaluating its feasibility, as well as the functional independence and quality of life of patients adhering to the program. Patients and Methods: This pragmatic clinical trial considered frail or pre-frail elderly patients hospitalized for acute coronary syndrome or decompensated heart failure between December 2021 and May 2023. After clinical stability and hospital discharge, those who agreed to participate were included in a run-in phase to identify physically active individuals. Patients adhering to the study proposal were then undergoing to an HBCR program consisting of moderateintensity physical conditioning for a minimum of 150 minutes per week over 6 months. During follow-up, they received instructional videos for physical activities and also participated in synchronous sessions, where they were virtually supervised by the team during physical conditioning. The control group comprised patients matched by sex and age who refused to participate in the HBCR program but received all recommendations for physical activity during their clinical follow-up. Intragroup analysis used Wilcoxon and McNemar tests, while intergroup comparison involved t-tests or Fisher's exact tests. P values < 0.05 were considered statistically significant. Results: The study cohort comprised 35 individuals (69% men) with a median age of 71 (range 68–76) years, with 23 participants in the HBCR group and 12 controls. The intervention proposed by the HBCR program did not reduce the primary composite outcome of death and hospitalization due to acute cardiovascular events, although it was not associated with any significant clinical complications. However, between T0 and T6, the HBCR group demonstrated a significant increase in the distance covered in the 6-minute walk test (P = 0.001), improved performance in the Timed Up and Go test (P = 0.005), and an improvement in their overall health perception in the SF-36 (P = 0.014). Additionally, we observed a significant reduction in their frailty indices (P = 0.027), also captured by the Edmonton Frail Scale (P < 0.001), reflecting improvements in cognition (P = 0.009), functional independence (P = 0.004), nutrition (P = 0.008), and the Timed Up and Go test (P = 0.025). Conclusions: The HBCR program did not reduce mortality or hospitalizations, but it was safe and showed promise in reducing frailty syndrome and promoting greater autonomy in the elderly.