A new study highlights the lifesaving potential of cardiac rehabilitation (CR) for frail older adults undergoing heart procedures. Published in Circulation: Cardiovascular Quality and Outcomes, the research reveals that while frail Medicare beneficiaries are less likely to participate in CR, those who do see a substantial reduction in 1-year mortality.
The study analyzed Medicare claims for over 500,000 patients aged around 76 who underwent percutaneous or surgical revascularization or aortic valve replacement between 2016 and 2018. Frailty was assessed using a validated claims-based frailty index, and patients were grouped into quartiles from least to most frail.
Researchers found that only 37.7% of patients attended at least one CR session within a year of discharge. Participation sharply declined with increasing frailty: nearly half of the least frail patients attended CR, compared with just 24% of the frailest group.
Unsurprisingly, frailty was linked to higher 1-year mortality, ranging from 2.5% among the least frail to 16.9% among the frailest patients. However, CR participation dramatically altered these outcomes. The mortality reduction associated with CR was most pronounced among the frailest patients—9.2% versus 1.7% in the least frail underscoring CR’s potential to counteract the risks of frailty.
The findings indicate that frail patients, who are often overlooked for rehabilitation, may actually gain the greatest benefit from cardiac rehab after major heart procedures.
Supporting this, a study by Rouleau et al. reported that improvements in cardiorespiratory fitness and lipid control partially account for the mortality benefits of cardiac rehabilitation (CR) and highlight these factors as important targets for secondary prevention
The study emphasizes the need to increase CR participation, particularly among frail older adults, to improve survival outcomes after cardiovascular interventions. CR not only supports recovery but may also play a critical role in closing the gap in post-procedural mortality linked to frailty.
Reference
- Bauer TM, Hou H, Fleigner M, Likosky DS, Pagani FD, Sukul D, Keteyian SJ, Thompson MP. Association Between Cardiac Rehabilitation and 1-Year Mortality by Frailty Level in Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes. 2025 Nov 21:e012009.
- Rouleau CR, Chirico D, Wilton SB, MacDonald MK, Tao T, Arena R, et al. Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study. Journal of the American Heart Association. 2024 May 21;13(10):e033568.