Association of In-Hospital Cardiac Rehabilitation on Hospital-Associated Disability for Octogenarian Patients With Acute Myocardial Infarction ― An Insight From the JROAD-DPC Database ―

Background: This study aimed to determine the status of in-hospital cardiac rehabilitation (CR) and hospital-associated disability (HAD) for patients with acute myocardial infarction (AMI) aged >80 years. Methods and Results: This study involved the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination databases, and included patients who were hospitalized with AMI from April 2014 to March 2021. Patients were categorized by the daily amount of CR: NA, not applicable; Low, 20-30 min; Moderate, 30-40 min; and High, >40 min. Activities of daily living were assessed using the Barthel index (BI) score, and evaluated at both admission and discharge. This study defined HAD as a >= 5-point decrease in BI score at discharge compared with admission. A total of 12,061 eligible patients were selected (age 83.0 years; 36.4% female), of which 2.7% had HAD (NA, 2.0%; Low, 4.7%; Moderate, 2.6%; High, 2.6%). The Low group was more likely to develop HAD. Chronological trends in hospital stay and incidence rate of HAD gradually decreased with the increased in-hospital CR participation rate. The multivariable logistic regression analysis revealed that the daily amount of CR was selected as an independent associated factor for preventing HAD (odds ratio 0.737; 95% confidence interval 0.567-0.960; P=0.023). Conclusions: Our results revealed that higher amounts of in-hospital CR for patients with AMI should be performed, especially in octogenarians.