<div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="255652188" paraeid="{2d3d3d2f-e54d-4672-ba5b-d87e7a18740b}{102}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Older, frailer</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>patients<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">who experience a heart attack<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">should not be excluded from access to<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">multidomain cardiac rehabilitation (CR),</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>despite perceived CR limitations associated with frailty status, a sub-analysis of the<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">PIpELINe</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>trial shows.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1237020303" paraeid="{8d9133d7-6cbf-434c-8490-9ae23116d526}{161}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">These data were reported by Beatrice Dal Passo, MD, of the Azienda<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">Ospedaliero</span><span> </span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">Universitaria</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>di Ferrara, Italy, and colleagues, in<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">a manuscript published online in<span> </span></span></span><em><span class="NormalTextRun SCXW54824593 BCX0">Circulation: Population Health and Outcomes</span></em><span class="NormalTextRun SCXW54824593 BCX0">.</span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="666770552" paraeid="{b9e2d8f1-2820-44b1-b3b9-0daab9c61958}{200}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">After myocardial infarction (MI) in older patients, frailty poses an extra prognostic risk. Frail patients are less likely to<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">participate</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>in CR programs because clinicians are less likely to provide a referral or recommendation.</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>Little is known about how frailty<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">modifies</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>the relationship between CR and clinical outcomes in frail patients.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1354015430" paraeid="{e1b5520f-6736-4c7d-90df-31e0dac77d05}{56}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">The<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">PIpELINe</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>(Physical Activity Intervention in Elderly Patients)</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>trial enrolled 512 MI patients in Italy<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">between March 2020 and November 2023,<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">and randomized participants 2:1 to undergo CR or standard care after heart attack.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1595197451" paraeid="{866a6092-0658-4067-a4eb-096463bdbfc9}{184}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">The Fried Frailty Phenotype was used to assess frailty levels in the<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">PIpELINe</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>patients. Patients were categorized as<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">nonfrail</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>or frail. Prefrail<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">patients were</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>included in the frail c</span><span class="NormalTextRun SCXW54824593 BCX0">ategory.</span><span> </span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1769271296" paraeid="{fe02e5af-2a19-4b78-8974-461f1c4b34f8}{229}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">A composite of cardiac health or unanticipated hospitalization for cardiac causes within 1-year after randomization was the primary outcome in this<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">study.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1979565469" paraeid="{71d27c43-05fc-44ce-8328-6d7b48c8dffa}{21}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Investigators in this present analysis<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">sought</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>to<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">determine</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>how frailty<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">impacted</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>clinical outcomes with CR versus without CR.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="918780392" paraeid="{b1f283c7-6348-4970-9a1b-a1848033b5bb}{218}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Of the 512 patients in<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">PIpELINe</span><span class="NormalTextRun SCXW54824593 BCX0">, 350 were categorized as frail (n=232 randomized to CR).<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">The frail patients were older (median age=80 years) than </span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">nonfrail</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>patients.</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>The percentage of women who were frail was also higher versus<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">nonfrail</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>(41.7% vs 24.7%).</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="485116525" paraeid="{7bb666cf-0c75-488d-8439-59f4e84e442e}{82}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Frail patients were more likely to experience the primary outcome (17.7%) compared with<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">nonfrail</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>patients (9.9%; hazard ratio [HR]=1.59; 95% confidence interval [CI]=</span><span class="NormalTextRun SCXW54824593 BCX0">0.89-2.82; p=0.117), but this was not statistically significant.</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1727474110" paraeid="{68190b8d-9268-4f1e-90dd-9ff5a56801a3}{195}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Frail patients still<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">benefit</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>from multidomain CR, however. Those who<span> </span></span><span class="NormalTextRun SCXW54824593 BCX0">participated</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>in CR had a lower risk of the primary outcome versus frail patients who received usual care (HR=0.57; 95% CI</span><span class="NormalTextRun SCXW54824593 BCX0">=0.34-0.94; p=0.028).</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1462899842" paraeid="{02a7b872-adcf-4abb-a531-c779fa40811f}{33}"><span class="NormalTextRun SCXW54824593 BCX0">This sub-analysis showed the importance of including frail patients in multidomain CR when they are recovering from MI.</span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1296401858" paraeid="{d3a363d7-d3cc-44e0-8851-1c211c670b15}{156}"><span class="NormalTextRun SCXW54824593 BCX0">“</span><span class="NormalTextRun SCXW54824593 BCX0">These findings challenge prevailing assumptions that contribute to the underuse of rehabilitation in frail patients and support a shift in clinical practice: frailty assessment should be used to guide prioritization and personalization of secondary prevention strategies rather than to restrict access to evidence-based care,” the investigators concluded.</span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="287297724" paraeid="{26a4ed33-6feb-4a2a-b843-838fd784428a}{107}"><strong><span class="NormalTextRun SCXW54824593 BCX0">Source:</span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1597721615" paraeid="{6c8dc931-e38b-44fc-8622-cf226f6fa63a}{84}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Dal Passo B, Tonet E, Raisi A, et al. Effectiveness of multidomain cardiac rehabilitation after myocardial infarction by patient frailty: Prespecified subgroup analysis of the<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">PIpELINe</span><span class="NormalTextRun SCXW54824593 BCX0"><span> </span>trial.<span> </span></span></span><em><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Circ </span><span class="NormalTextRun SpellingErrorV2Themed SCXW54824593 BCX0">Popul</span><span class="NormalTextRun SCXW54824593 BCX0"> Health Outcomes</span></span></em><span class="NormalTextRun SCXW54824593 BCX0">. 2026 August (Article in Press).</span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW54824593 BCX0"> <p class="Paragraph SCXW54824593 BCX0" lang="EN-US" paraid="1606226063" paraeid="{26a4ed33-6feb-4a2a-b843-838fd784428a}{171}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW54824593 BCX0"><span class="NormalTextRun SCXW54824593 BCX0">Image Credit: </span><span class="NormalTextRun SCXW54824593 BCX0">toa555</span><span class="NormalTextRun SCXW54824593 BCX0"> </span><span class="NormalTextRun SCXW54824593 BCX0">– stock.adobe.com</span></span><span class="EOP Selected SCXW54824593 BCX0" data-ccp-props="{}"> </span></strong></p> </div>