Prognostic Impact of Cardiac Rehabilitation in Older Patients With Cardiovascular Disease: A Three‐Period Analysis Around the COVID ‐19 Pandemic

AIM: During the COVID-19 pandemic, some patients experienced difficulty attending regular in-hospital cardiac rehabilitation (CR) after discharge. This study investigated the impact of CR in older patients with cardiovascular disease (CVD) by comparing outcomes before, during, and after the COVID-19 pandemic. METHODS: In this post hoc analysis of a single-center registry, 505 patients aged ≥ 65 years (mean age 82) were included. Outcomes were compared between participants in a 4-month outpatient CR program after discharge and non-participants. Patients were categorized into three periods: before the COVID-19 pandemic (n = 173), during the COVID-19 pandemic (n = 217), and after the COVID-19 pandemic (n = 105). Cardiovascular (CV) events and non-CV events were followed. RESULTS: As the primary endpoint, cumulative hospitalization for worsening HF was significantly lower in the CR group across all time periods (p < 0.001, p < 0.001, and p = 0.019, respectively). Cumulative non-CV event-free survival was significantly higher in the CR group before and after the COVID-19 pandemic (p < 0.001, p = 0.030, respectively) but showed no significant differences during the pandemic. Before the pandemic, participation in CR was significantly associated with hospitalization for worsening HF (hazard ratio [HR], 0.538; 95% confidence interval [CI], 0.294-0.982; p = 0.043). During and after the pandemic, this association was not. CONCLUSION: CR appears to have a protective effect against CV events in older patients with CVD. Although the COVID-19 pandemic disrupted this positive trend, the findings support CR as a cornerstone of recovery in this population.