Factors Associated With Cardiac Rehabilitation Participation in Older Adults After Myocardial Infarction THE SILVER-AMI STUDY

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.

Automated summary

This study aimed to examine factors associated with the utilization of cardiac rehabilitation (CR) among older adults hospitalized with acute myocardial infarction (AMI). The study found that older age, longer hospitalization, lower educational level, visual and cognitive impairments, and living alone were associated with decreased likelihood of CR participation, while receipt of diagnostic and interventional procedures was associated with increased likelihood of CR participation.