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With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility-based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth-CR) and evidence being generated in this field.

Background: Among older adults with cardiovascular disease (CVD), cardiac rehabilitation (CR) has multiple benefits including improved quality of life and reduced mortality. Despite the known benefits of CR, early termination (ET) by patients (attending <12/36 recommended sessions) may attenuate these benefits. Our aim was to determine the incidence of ET in our older adult patient population, as well as risk factors associated with this outcome.
Method(s): We reviewed records from 792 consecutive older adult patients (>= 65 years old) enrolled in the NYU Langone Rusk CR program (2013-2017). Sessions attended, demographics, comor-bidities, and primary referral diagnosis were abstracted. We analyzed the overall rate of ET (defined as attending <12 sessions). Categorical variables were described with percentages and continuous variables with mean values. Multivariable logistic regression was subsequently used to analyze predictors of ET, considering age, race, ethnicity, sex, body mass index, diabetes, chronic lung disease, coronary artery disease, heart failure, and stroke.
Result(s): In our total study population, mean age was 74 +/- 7 years, mean BMI was 26 +/- 5, 38% were female, and 18% were nonwhite. Most patients (65%) were referred to CR due to ischemic heart disease (chronic stable angina, post-myocardial infarction, CABG, or elective PCI), with an additional 23% referred for valvular heart disease, 9% for systolic heart failure, and 3% for congenital heart disease. Early termination occurred in 129 patients (16.3%). Patients who terminated early were significantly older (75.6 vs. 73.9, p=0.005) and less likely to have coronary artery disease (13.6% vs. 19.5%, p=0.03). After multivariable logistic regression, the independent risk factors for ET were age (adjusted OR 1.04, 95% CI 1.01-1.07) and Hispanic ethnicity (adjusted OR 2.32, 95% CI 1.01-5.33).
Conclusion(s): Nearly 1 in 6 older adults terminated CR within 1 month (<12/36 sessions), potentially limiting the benefits of CR within this subgroup. Among factors we analyzed, age and Hispanic ethnicity were risk factors for ET, but the overall strength of associ-ation was weak. Further research is necessary to identify novel risk factors for ET in order to better target prevention efforts

Background and Purpose/UNASSIGNED:Sudden cardiac death (SCD) causes an estimated 200,000 to 450,000 deaths per year in the United States. Although permanent implantation of an internal cardiac defibrillator (ICD) offers a preventive intervention, the required assessment period for determining need creates vulnerability for patients who will benefit from this protection. The Wearable Cardioverter Defibrillator (WCD) for use as interim protection is rapidly increasing. There are no rehabilitation guidelines for patients wearing them. This article reviews the WCD's purpose, considers implications and current challenges for use during rehabilitation, and illustrates this with a case report. Case Description/UNASSIGNED:A 51-year-old male with coronary artery disease (CAD) following prolonged hospitalization was fitted with a WCD during evaluation for ICD. During inpatient rehabilitation, the therapy plan required unique considerations because of the presence of the WCD. Outcomes/UNASSIGNED:Recapitulating the patient's rehabilitation course illustrates the WCD's challenges, the benefits to exercise progression, and the safety measures utilized. The patient gained functional independence, with uninterrupted care, in the presence of the WCD. Discussion/UNASSIGNED:Essential to uninterrupted and successful rehabilitative care for WCD-wearing patients are knowledgeable clinicians, attention to safety, and sufficient patient/caregiver education. Because of increasing clinical prevalence in rehabilitation, it is critically important to share clinical experience and eventually conduct a systematic assessment.