Cardiology in Older Persons: Identifying Opportunities to Prevent Deconditioning Through Early Multidisciplinary Rehabilitation

Cardiology in Older Persons: Identifying Opportunities to Prevent Deconditioning Through Early Multidisciplinary Rehabilitation

Introduction:
Older adults admitted under cardiology are at increased risk of frailty, functional decline and hospital-associated deconditioning. Acute illness, invasive procedures, complications and prolonged hospitalisation can further reduce mobility and independence. We undertook an audit of patients admitted under the Cardiology in Older Persons (COPs) pathway to identify opportunities for earlier rehabilitation and functional support.

Method:
A retrospective descriptive audit of 111 patients admitted under the COPs pathway was undertaken. Demographic characteristics, Clinical Frailty Scale (CFS), cardiology procedures, inpatient complications, therapy involvement, length of stay (LOS) and 30-day outcomes were reviewed. Associations between clinical factors and LOS were explored descriptively.

Results:
The median age was 86 years, median CFS was 4 and median LOS was 7 days. Sixty-six percent underwent a cardiology procedure and 60% experienced at least one documented inpatient complication, with complications associated with longer hospitalisation. Thirty-six patients had a CFS ≥5, with median LOS of 7 days compared with 6 days in those with CFS <5. Therapy input was documented in only 35% of patients, suggesting potential under-recognition or delayed identification of rehabilitation needs. Among patients with a recorded procedural decision, those with a decision by day 1 had a median LOS of 3.5 days compared with 8 days when the decision occurred later. Thirty-day readmission and mortality were 8% and 6%, respectively.

Conclusion(s):
This audit highlights opportunities to reduce deconditioning and preserve functional independence in older cardiology patients. Early cardiology–geriatrics co-management could incorporate day-0/1 frailty and functional assessment with proactive discharge planning. Early therapy assessment from the initial stages of admission could therefore increase rehabilitation coverage by up to 65 percentage point. This is particularly relevant given evidence linking hospitalisation with functional decline¹.Earlier procedural decision-making was associated with a 56% shorter median LOS. This gives an overall improvement in functional independence and patient-centred outcomes significantly.(2,3)

References:

1.Conroy, S.P., Bardsley, M., Smith, P., et al. (2019) ‘Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study’, Health Services and Delivery Research, 7(15).

2.Swinnerton, E. and Price, A. (2023) ‘Recognising, reducing and preventing deconditioning in hospitalised older people’, Nursing Older People, 35(2), pp. 34–41.

3.Westlake, M., Cowley, A., Robinson, K., Gordon, A.L., et al. (2025) ‘Towards a common definition of hospital-acquired deconditioning in adults: a scoping review’, BMJ Open, 15, e086976.