Purpose: 

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.

Methods: 

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.

Results: 

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.

Conclusions: 

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.

中文翻译：

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老年人心肌梗塞后参与心脏康复的相关因素：SILVER-AMI 研究

目的： 

心脏康复（CR）是急性心肌梗死（AMI）后二级预防的一个关键方面。尽管越来越多的证据表明 CR 对老年人有独特的益处，但它仍然没有得到充分利用。我们的目的是检查因 AMI 住院的老年人中与 CR 使用相关的特定人口统计学、临床和功能因素。

方法： 

我们的项目使用了 SILVER-AMI 研究的数据，这是一项针对年龄≥75 岁因 AMI 住院患者的全国性前瞻性队列研究，并在出院后对他们进行了 6 个月的随访。收集了有关人口统计、临床和心理社会因素以及功能和感觉障碍的广泛基线数据。CR 的利用情况是通过 6 个月时的调查收集的。在多变量调整逻辑回归模型中采用向后选择来确定 CR 使用的独立预测因素。

结果： 

在本次分析中纳入的 2003 名参与者中，有 779 名 (39%) 报告在出院后 6 个月内参与了 CR。年龄较大、住院时间较长、受教育年限≤12 年、视力障碍、认知障碍和独居与 CR 参与可能性降低相关；接受诊断和介入手术（即心导管插入术、经皮冠状动脉介入治疗和冠状动脉搭桥术）与 CR 参与的可能性增加相关。

结论： 

人口统计和临床因素，以及老年中常见的功能和感觉障碍，与老年 AMI 患者出院后 6 个月的 CR 参与相关。这些结果强调了增加老年人 CR 使用率的机会，并确定那些有不参与风险的人。