TOPLINE

Among older patients recovering from myocardial infarction (MI), lower physical performance at 1 month was associated with a higher risk for a composite of cardiovascular death or unplanned cardiovascular hospitalisation over the following year; gait speed emerged as the single strongest predictor of adverse cardiovascular outcomes.

METHODOLOGY

• Researchers conducted a prespecified subanalysis of a prospective, multicentre clinical trial (PIpELINe) to evaluate whether physical performance assessed using the Short Physical Performance Battery (SPPB) at the start of cardiac rehabilitation predicted cardiovascular outcomes over 1 year in older patients after MI.
• The analysis included 512 patients aged 65 years or older with an SPPB score of 4-9 at 1 month post-discharge between 2020 and 2023 who were randomly assigned to receive either a multidomain rehabilitation programme or standard care.
• The SPPB combines gait speed, chair-rise ability, and standing balance components. Patients were grouped into lower (4-6) and higher (7-9) SPPB score categories for analysis.
• The multidomain intervention combined management of cardiovascular risk factors, personalised nutrition guidance, and an exercise programme, with supervised follow-up visits scheduled at 30, 60, 90, 180, 270, and 365 days after hospital discharge.
• The primary outcome was a composite of cardiovascular death or unplanned hospitalisation for cardiovascular reasons within 1 year of follow-up.

TAKEAWAY

• Patients with higher baseline SPPB scores had a significantly lower risk for the composite of cardiovascular death or unplanned cardiovascular hospitalisation than those with lower scores (hazard ratio [HR], 0.51; P < .01).
• The benefit of multidomain rehabilitation was consistent regardless of baseline physical performance, with no significant interaction noted between SPPB scores and treatment assignment (P = .45).
• Among individual SPPB components, gait speed showed the strongest association with outcomes, with each one-point increase in the SPPB score associated with a 50% lower risk for the primary outcome (HR, 0.50; P < .001).
• Patients whose SPPB score increased by at least one point during follow-up had a lower risk for adverse cardiovascular events, with the effect being most pronounced among those in the multidomain rehabilitation group (HR, 0.32; P < .001).

IN PRACTICE

"Overall, [the study] findings support the integration of simple functional performance measures into post-myocardial infarction care to enhance risk stratification and guide more personalized rehabilitation strategies," the researchers wrote.

SOURCE

The study was led by Andrea Raisi, University of Ferrara, Ferrara, Italy. It was published online on September 16, 2026, in the European Journal of Preventive Cardiology.

LIMITATIONS

As the study included only patients with SPPB scores of 4-9, the results may not be applicable to those with very poor or very good functional status. Physical performance was assessed at 1 month after hospital discharge, which excluded patients who did not survive the early recovery period and may have introduced survivor bias. The 1-year follow-up period limited the assessment of longer-term functional changes and their relationship with clinical outcomes.

DISCLOSURES

Three authors received funding from the Italian Ministry of Health to conduct the PIpELINe study. The authors declared having no financial ties — such as honoraria, educational grants, speakers bureau participation, membership, employment, consulting roles, stock or other equity holdings, or expert testimony/patent-licensing arrangements — to any organisation with an interest in this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.