Effetti dell'esercizio fisico sul consumo di farmaci in pazienti anziani con patologia cardiovascolare

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in the elderly, frequently accompanied by comorbidity. Age, comorbidity, disability and depression are known to increase drug consumption. In the elderly, several types of interventions and strategies have been tested to reduce drug use; among these, physical activity (PA) improves diabetes and hypertension control, prevents frailty, disability and reduces mortality. Objective: Aim of the study was to evaluate the effect of physical activity the month prior to cardiovascular event on drugs consumption independently by the effect of age, comorbidity, disability, depression and cognitive impairment. Methods: We enrolled 313 elderly (>65 years) patients hospitalized for Cardiac Rehabilitation from 01.01.2007 to 30.09.2009 because of a major cardiovascular event (AMI, PTCA, CABG and heart failure decopensation). In all patients number of drugs used was collected and were also evaluated physical activity by means of Physical Activity Scale for the Elderly (PASE), disability by means of Activity of Daily Living (ADL), comorbidity by means of Cumulative Index of Comorbidity (CIRS), depressive symptomatology by means of Geriatric Depression Scale (GDS) and cognitive function by means of Mini Mental State Examination (MMSE). Results: Mean age was 73.2±5.6 years, 38.6% was 75 years and over. 58.9% were male. The 60.8 % of the sample was hospitalized after BPAC, 23.9 % after valve replacement, 23.2 % for heart failure decompensation and 10.7 % after acute myocardial infarction and/or PTCA. Mean drug consumption was 8.4±2.1 (range 4-14) and mean PASE score PASE was 72.4±45.0 (range 0-192). Univariate analysis conducted on tertiles of drug consumption (0-7; 8-9, ≥9) demonstrated an increase in age, GDS, CIRS and ADL lost within the tertiles of drug consumption, while an inverse relation was found for MMSE and PASE score (72±58, 64±55, 60±50; p for trend 0.023). In multivariate regression analysis PASE score predicts drug consumption (B = -0.198; p=0.023) independently by the effect of age, GDS, CIRS, ADL and MMSE. Conclusion: This is the first observation conducted on elderly patients demonstrating that recreational activity is associated with lower drug consumption independently by the effect of age, comorbidity, disability, GDS and MMSE.