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Article: Cardiac rehabilitation protocols in the elderly.

Silverii, Maria Vittoria / Pratesi, Alessandra / Lucarelli, Giulia / Fattirolli, Francesco

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2020 Volume 90, Issue 4

Abstract: Cardiac rehabilitation (CR) is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. Cardiovascular disease is prevalent in older adults and is the leading cause of death and major ... ...

Abstract	Cardiac rehabilitation (CR) is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. Cardiovascular disease is prevalent in older adults and is the leading cause of death and major disability in adults ≥75 years of age. The mean age of patients eligible for CR is increasing, with greater complexity and specific geriatric features, such as multimorbidity, frailty, and disability. In this population, CR interventions should be aimed to prevent disability and preserve the residual functional capacity. Every patient should be assessed with a multidimensional evaluation that includes clinical, functional, emotional, cognitive and social domains. Exercise-based CR programs have shown to be effective in improving function and quality of life, by reducing disability and age-related deconditioning and contributing favorably to improved health outcomes in an aged population. Very old and frail patients seem to get an even greater potential benefit, and an early start after an acute event can prevent the post-hospital syndrome. Despite these proven benefits, CR is often underused in this population and a great effort should be done to encourage them to attend these programs. There are just a few studies about CR programs in very old and frail patients, therefore a future goal should be to fill this gap.
MeSH term(s)	Aged ; Cardiac Rehabilitation ; Cardiovascular Diseases ; Exercise Therapy ; Frail Elderly ; Frailty/epidemiology ; Humans ; Quality of Life
Language	English
Publishing date	2020-11-20
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2020.1253
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Article: Cardiovascular prevention and rehabilitation in the elderly: evidence for cardiac rehabilitation after myocardial infarction or chronic heart failure.

Fattirolli, Francesco / Pratesi, Alessandra

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2016 Volume 84, Issue 1-2, Page(s) 731

Abstract: Cardiac rehabilitation in the elderly today often represents a utopia. The international scientific literature takes little into account this type of prescription for old people, although they represent a large and growing proportion of cardiac patients, ...

Abstract	Cardiac rehabilitation in the elderly today often represents a utopia. The international scientific literature takes little into account this type of prescription for old people, although they represent a large and growing proportion of cardiac patients, with acute coronary syndrome or heart failure, which we have to manage in everyday life. Furthermore, interventions of health education, clinical follow up, rehospitalisation prevention and prescription of tailored exercise, are sometimes more necessary in this kind of patients, given the presence of multimorbidity, functional dependence, frailty, sarcopenia, social neglect. Most of the data on the feasibility, safety and efficacy of cardiac rehabilitation are favourable, but they are few and apparently not strong enough to convince the medical community. Therefore is necessary to join efforts to identify the geriatric patient's peculiarities and plan a suitable program of cardiac rehabilitation, which takes into account the multi-dimensionality and complexity of typical problems of the elderly, for which the classical cardiac outcomes can be limited.
MeSH term(s)	Aged ; Cardiac Rehabilitation/methods ; Chronic Disease ; Heart Failure/rehabilitation ; Humans ; Myocardial Infarction/rehabilitation ; Physical Conditioning, Human
Language	English
Publishing date	2016-06-22
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2015.731
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Article ; Online: Predictors of physical frailty improvement in older patients enrolled in a multidisciplinary cardiac rehabilitation program.

Baldasseroni, Samuele / Silverii, Maria Vittoria / Herbst, Andrea / Orso, Francesco / Di Bari, Mauro / Pratesi, Alessandra / Burgisser, Costanza / Ungar, Andrea / Marchionni, Niccolò / Fattirolli, Francesco

Heart and vessels

2023 Volume 38, Issue 8, Page(s) 1056–1064

Abstract: Cardiac rehabilitation (CR) improves clinical and functional recovery in older patients after acute cardiac syndromes, whose outcome is influenced by cardiac disease severity, but also by comorbidity and frailty. The aim of the study was to analyze the ... ...

Abstract	Cardiac rehabilitation (CR) improves clinical and functional recovery in older patients after acute cardiac syndromes, whose outcome is influenced by cardiac disease severity, but also by comorbidity and frailty. The aim of the study was to analyze the predictors of physical frailty improvement during the CR program. Data were collected in all patients aged > 75 years consecutively admitted from 1 January to December 2017 to our CR, consisting of 5-day-per-week of 30-min session of biking or calisthenics on alternate days for 4 weeks. Physical frailty was measured with short physical performance battery (SPPB) at the entry and the end of CR. Outcome was represented by an increase of at least 1 point in the SPPB score from baseline to the end of the CR program. In our study population of 100 patients, mean age 81 years, we demonstrated that a strong predictor of improvement in SPPB score was the poorer performance in the test at baseline; for Δ-1 point of score, we registered an OR 2.50 (95% CI = 1.64-3.85; p = 0.001) of probability to improve the physical performance at the end of CR. Interestingly those patients with worse performance at SPPB balance and chair standing task showed greater probability of ameliorating their physical frailty profile at the end of CR. Our data strongly suggest that CR program after acute cardiac syndrome produces a significant physical frailty improvement in those patients with worse frailty phenotype with an impairment in chair standing or balance at entry.
MeSH term(s)	Humans ; Frailty/diagnosis ; Cardiac Rehabilitation ; Recovery of Function ; Hospitalization ; Physical Functional Performance
Language	English
Publishing date	2023-03-30
Publishing country	Japan
Document type	Journal Article
ZDB-ID	89678-0
ISSN	1615-2573 ; 0910-8327 ; 0935-736X
ISSN (online)	1615-2573
ISSN	0910-8327 ; 0935-736X
DOI	10.1007/s00380-023-02254-9
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Article ; Online: Prediction of worsening postoperative renal function in older candidates to elective cardiac surgery: Choosing the best eGFR formula may not be enough.

Baldasseroni, Samuele / Bari, Mauro Di / Pratesi, Alessandra / Rivasi, Giulia / Stefàno, Pierluigi / Olivo, Giuseppe / Meo, Maria Laura Di / Orso, Francesco / Pace, Stefano Del / Ungar, Andrea / Marchionni, Niccolò

Heart & lung : the journal of critical care

2023 Volume 62, Page(s) 28–34

Abstract: Background: Though renal impairment is highly prevalent in older patients and influence post-operative outcomes in cardiac surgery; its prognostic relevance is debated and not fully assessed by surgical risk scores.: Objective: We investigated the ... ...

Abstract	Background: Though renal impairment is highly prevalent in older patients and influence post-operative outcomes in cardiac surgery; its prognostic relevance is debated and not fully assessed by surgical risk scores. Objective: We investigated the predictive role of estimated glomerular filtration rate formulas for in-hospital worsening renal function (WRF) after cardiac surgery. Methods: We prospectively enrolled in single-center cohort study, patients aged ≥ 75 years candidate to elective cardiac surgery. Four creatinine-based equations were used to calculate estimated glomerular filtration rate (eGFR) formulas: Cockroft-Gault, Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology, and Berlin Initiative Study 1 formulas. Each patient underwent geriatric and clinical evaluation before surgery with calculation of the Society of Thoracic Surgeons scores. In-hospital WRF was defined as a composite of an increase in SCr ≥0.5 mg/dl or the occurrence of grade III KDIGO acute kidney injury. The association between each eGFR equation, alone and in models including clinical variables, and WRF was analyzed using logistic regressions and ROC analysis. Results: WRF occurred in 69 patients (19.8%), and the predictors of WRF were previous acute myocardial infarction, hypertension, 4-mt gait speed performance, and preoperative eGFR, irrespective of the equation used. With all equations, inclusion of these additional variables in the logistic regression models improved the prediction of WRF (AUCs 0.798-0.810). Conclusions: An accurate assessment of renal function and of physical performance should be incorporated into cardiac surgery risk scores to improve prediction of in-hospital WRF and, hence, risk stratification in older adults undergoing elective cardiac surgery.
MeSH term(s)	Humans ; Aged ; Glomerular Filtration Rate ; Cohort Studies ; Renal Insufficiency, Chronic ; Cardiac Surgical Procedures/adverse effects ; Myocardial Infarction ; Kidney/physiology
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	193129-5
ISSN	1527-3288 ; 0147-9563
ISSN (online)	1527-3288
ISSN	0147-9563
DOI	10.1016/j.hrtlng.2023.05.008
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Article ; Online: Medical treatment in multivessels coronary disease.

Fattirolli, Francesco / Pratesi, Alessandra / Venturini, Simone

Journal of cardiovascular medicine (Hagerstown, Md.)

2017 Volume 18 Suppl 1, Page(s) e18–e22

MeSH term(s)	Cardiovascular Agents/therapeutic use ; Coronary Disease/drug therapy ; Humans ; Myocardial Infarction/diagnosis ; Myocardial Infarction/drug therapy ; Prognosis
Chemical Substances	Cardiovascular Agents
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	2223461-5
ISSN	1558-2035 ; 1558-2027
ISSN (online)	1558-2035
ISSN	1558-2027
DOI	10.2459/JCM.0000000000000442
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Article ; Online: La gestione del paziente con diabete di tipo 2 in Cardiologia Preventiva e Riabilitativa. Expert opinion della Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P).

Ambrosetti, Marco / Fattirolli, Francesco / Maranta, Francesco / Ruzzolini, Matteo / Rizzo, Manfredi / Mureddu, Gian Francesco / Griffo, Raffaele / Venturini, Elio / Giallauria, Francesco / Orso, Francesco / Pratesi, Alessandra / Patti, Angelo / Perone, Francesco

Giornale italiano di cardiologia (2006)

2023 Volume 24, Issue 10, Page(s) 834–843

Abstract: Patients with diabetes, regardless of their cardiovascular disease and their index event, are more and more often referred to Cardiac Rehabilitation Units. These patients usually show high or very high cardiovascular risk, marked disability and poor ... ...

Title translation	Management of patients with type 2 diabetes during cardiac prevention and rehabilitation. An expert opinion from the Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P).
Abstract	Patients with diabetes, regardless of their cardiovascular disease and their index event, are more and more often referred to Cardiac Rehabilitation Units. These patients usually show high or very high cardiovascular risk, marked disability and poor quality of life. Furthermore, those with older age, frailty, and female sex have even more rehabilitative needs, thus requiring fine individualized approaches. Consequently, in order to identify their therapeutic goals, the glycemic target should be pursued together with the effective reduction of the global cardiovascular risk. Modern exercise protocols are based on the synergic effect of both aerobic and strength training of moderate and high effort intensities, in order to achieve improvements of cardiorespiratory fitness and glycemic values as well. Exercise training and nutritional intervention are strictly related during the rehabilitation program, thus promoting better lifestyle in the long term too. New antidiabetic drugs (such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists) should be included into a specific "patient journey" along with other core components of the rehabilitation program. Therefore, the active role of all allied professionals (namely nurses, physiotherapists, dietitians and psychologists) is essential to the success of the cardiometabolic team. Diabetes should be routinely included in the outcome evaluation of cardiac rehabilitation programs and in every follow-up plan through a successful crosstalk among cardiologists, diabetologists and patients.
Language	Italian
Publishing date	2023-09-28
Publishing country	Italy
Document type	English Abstract ; Journal Article
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
DOI	10.1714/4100.40985
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Article ; Online: New Drugs for Heart Failure: What is the Evidence in Older Patients?

Orso, Francesco / Herbst, Andrea / Pratesi, Alessandra / Fattirolli, Francesco / Ungar, Andrea / Marchionni, NiccolÒ / Baldasseroni, Samuele

Journal of cardiac failure

2021 Volume 28, Issue 2, Page(s) 316–329

Abstract: Heart failure (HF) is a major public health concern, with a high prevalence in the older population. The majority of randomized clinical trials evaluating new emerging pharmacologic agents for HF (eg, angiotensin receptor-neprilysin inhibitors, sodium- ... ...

Abstract	Heart failure (HF) is a major public health concern, with a high prevalence in the older population. The majority of randomized clinical trials evaluating new emerging pharmacologic agents for HF (eg, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, intravenous iron for deficiency treatment, transthyretin stabilizers, soluble guanylate cyclase stimulators, cardiac myosin activators, and new potassium binders) have found positive results on various clinical outcomes, particularly in patients with reduced ejection fraction. These treatments might have an important role in the management of older patients as well. Nevertheless, trials demonstrating benefit of these drugs have involved patients significantly younger (on average, approximately 10 years) and fewer comorbidities than those commonly encountered in clinical practice. We describe the recent evidence regarding the newest HF drugs and their applicability to older individuals in terms of efficacy and safety, and we discuss their effects on outcomes particularly valuable to older patients, such as preservation of cognitive function, functional status, independence, and quality of life. Although available subgroup analyses seem to confirm efficacy and safety across the age spectrum for some of these drugs, their effects on older patients centered outcomes often have been neglected. Future HF trials should be designed to include older patients more representative of the real clinical practice, to overcome generalizability biases.
MeSH term(s)	Aged ; Angiotensin Receptor Antagonists/therapeutic use ; Heart Failure ; Humans ; Pharmaceutical Preparations ; Quality of Life ; Stroke Volume
Chemical Substances	Angiotensin Receptor Antagonists ; Pharmaceutical Preparations
Language	English
Publishing date	2021-08-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1281194-4
ISSN	1532-8414 ; 1071-9164
ISSN (online)	1532-8414
ISSN	1071-9164
DOI	10.1016/j.cardfail.2021.07.011
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Article: Predictors of 1-year outcome in very old patients managed in a Heart Failure Unit after an acute decompensation.

Baldasseroni, Samuele / Virciglio, Simona / Herbst, Andrea / Camartini, Viola / Pratesi, Alessandra / Salucci, Caterina / Franci Montorsi, Riccardo / D'Errico, Giovanni / Verga, Francesca / Ungar, Andrea / Fattirolli, Francesco / Marchionni, Niccolò / Orso, Francesco

European geriatric medicine

2022 Volume 13, Issue 6, Page(s) 1417–1424

Abstract: Purpose: Consensus exits about the clinical benefits of an early referral to multidisciplinary Heart Failure Unit-HFU for old frail patients with HF. Nevertheless, few data are present regarding the prognosis and the predictors of outcome in oldest-old ... ...

Abstract	Purpose: Consensus exits about the clinical benefits of an early referral to multidisciplinary Heart Failure Unit-HFU for old frail patients with HF. Nevertheless, few data are present regarding the prognosis and the predictors of outcome in oldest-old patients managed in this clinical setting. The aim of present study is to identify predictors of 1-year all-cause mortality in very old patients enrolled in our multidisciplinary HFU after an episode of acute decompensated HF. Methods: This study is a retro-prospective, single-center cohort analysis of patients managed in our multidisciplinary HFU. Inclusion criterion was diagnosis of HF according to ESC guidelines and age ≥ 85 years, while no exclusion criteria were pre-defined. Baseline clinical and comprehensive geriatric evaluations were recorded during the first visit and follow-up visits were repeated according to our standardized timetable protocol. Primary end-point was 1-year all-cause mortality. Results: We enrolled 75 patients aged 89.2 ± 2.8 years; 39 (52.0%) were females. During 1-year follow-up, seventeen patients (22.7%) died. Residual congestion with higher level (> 4) of EVEREST score (HR 1.24: 95% CI 1.04-1.47) and living alone (HR 3.34: 95% CI 1.16-9.64) resulted the two independent predictors of 1-year all-cause mortality at the multivariate Cox regression model. Finally, patients living alone and with an EVEREST score > 4 experienced a worse prognosis as clearly described by a steeper descendent Kaplan-Meier curve. Conclusion: In a very old population of patients after an acute decompensated HF, residual congestion and social isolation as living alone identify those with high risk of 1-year death.
Language	English
Publishing date	2022-10-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-022-00679-5
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Article ; Online: Cardiac Rehabilitation in Advanced aGE after PCI for acute coronary syndromes: predictors of exercise capacity improvement in the CR-AGE ACS study.

Baldasseroni, Samuele / Silverii, Maria Vittoria / Pratesi, Alessandra / Burgisser, Costanza / Orso, Francesco / Lucarelli, Giulia / Turrin, Giada / Ungar, Andrea / Marchionni, Niccolò / Fattirolli, Francesco

Aging clinical and experimental research

2022 Volume 34, Issue 9, Page(s) 2195–2203

Abstract: Background: The positive effect of cardiac rehabilitation (CR) on outcomes after acute coronary syndromes (ACS) is established. Nevertheless, enrollment rates into CR programs remain low, although ACS carry a high risk of functional decline particularly ...

Abstract	Background: The positive effect of cardiac rehabilitation (CR) on outcomes after acute coronary syndromes (ACS) is established. Nevertheless, enrollment rates into CR programs remain low, although ACS carry a high risk of functional decline particularly in the elderly. Aim: We aimed to determine if a multidisciplinary CR improves exercise capacity in an older population discharged after ACS systematically treated with PCI. Methods: CR-AGE ACS is a prospective, single-center, cohort study. All patients aged 75+ years consecutively referred to Cardiac Rehabilitation outpatient Unit at Careggi University Hospital, were screened for eligibility. Moderate/severe cognitive impairment, disability in 2+ basic activities of daily living, musculoskeletal diseases, contraindication to Cardiopulmonary Exercise Test, and diseases with an expected survival < 6 months, were exclusion criteria. Participants attended a CR program, based on 5-day-per-week aerobic training sessions for 4 weeks. Results: We enrolled 253 post-ACS patients with a mean age 80.6 ± 4.4 years. After CR, 136 (56.2%) 77 (31.3%) patients obtained, respectively, at least a moderate (∆+5%) or an optimal (∆+15%) increase in VO Conclusions: A CR program started early after discharge from ACS produces a significant increase in exercise capacity in very old patients with mild-to-moderate post-acute physical impairment. Baseline VO
MeSH term(s)	Activities of Daily Living ; Acute Coronary Syndrome/surgery ; Aged ; Aged, 80 and over ; Cardiac Rehabilitation ; Cohort Studies ; Exercise Test ; Exercise Therapy ; Exercise Tolerance ; Humans ; Percutaneous Coronary Intervention ; Prospective Studies
Language	English
Publishing date	2022-04-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2104785-6
ISSN	1720-8319 ; 1594-0667
ISSN (online)	1720-8319
ISSN	1594-0667
DOI	10.1007/s40520-022-02130-y
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Article ; Online: Lower extremity performance predicts length of hospital stay in older candidates to elective cardiac surgery.

Baldasseroni, Samuele / Di Bari, Mauro / Stefàno, Pierluigi / Pratesi, Alessandra / Mossello, Enrico / Ungar, Andrea / Del Pace, Stefano / Orso, Francesco / Herbst, Andrea / Lucarelli, Giulia / Fumagalli, Carlo / Olivo, Giuseppe / Marchionni, Niccolò

Experimental gerontology

2022 Volume 164, Page(s) 111801

Abstract: Introduction: Prolonged hospital stay must be considered as risk factor for poor outcomes after cardiac surgery; different variables have been advocated as predictors of in-hospital stay. Nevertheless, most patients requiring prolonged hospital stay are ...

Abstract	Introduction: Prolonged hospital stay must be considered as risk factor for poor outcomes after cardiac surgery; different variables have been advocated as predictors of in-hospital stay. Nevertheless, most patients requiring prolonged hospital stay are frail older subjects; thus, we hypothesized a significant influence of pre-operative physical performance, as a frailty measure, on in-hospital stay after elective cardiac surgery. Methods: In a prospective, single-center, cohort study we enrolled patients aged 75+ years referred to our Division of Cardiac Surgery at Careggi University Hospital, for their first elective cardiac surgery. All participants were preoperatively evaluated by a team composed by a cardiac surgeon, a cardiologist, an anaesthesist, and a geriatrician to assess global cardiac surgery risk; lower extremity performance was measured with the Short Physical Performance Battery-SPPB. Results: A total of 518 patients were included in the study. Mean age was 79.5 ± 3.3 years; 256 (49.4%) were women. Isolated coronary by pass graft was performed in 37 patients (7.1%), isolated valve surgery in 115 (22.0%), and combined cardiac surgery procedures in 366 (70,9%). In a multivariable model, SPPB score was strongly associated with hospital length of stay both as continuous, categorized and dichotomous variable (p < 0.001; p = 0.002; p = 0.002 respectively) in all study population, and in subgroup of patients candidate to cardiac surgery considered by the Society of Thoracic Surgeons calculator score (p = 0.023; p = 0.056; p = 0.013 respectively). Conclusions: Our findings support the use of pre-operative SPPB evaluation before elective cardiac surgery based on the independent ability to predict length of hospital stay.
MeSH term(s)	Aged ; Aged, 80 and over ; Cardiac Surgical Procedures/adverse effects ; Cohort Studies ; Female ; Humans ; Length of Stay ; Lower Extremity/surgery ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies
Language	English
Publishing date	2022-04-11
Publishing country	England
Document type	Journal Article
ZDB-ID	390992-x
ISSN	1873-6815 ; 0531-5565
ISSN (online)	1873-6815
ISSN	0531-5565
DOI	10.1016/j.exger.2022.111801
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