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Risk stratification for exercise training in cardiac patients: do the proposed guidelines work?
M Paul-Labrador1, P Vongvanich, C N Merz
1Department of Medicine, Cedars-Sinai Medical Center Burns, Los Angeles, CA 90048, USA.
Insights
Current risk stratification guidelines for supervised exercise in cardiovascular disease patients are not predictive of complications. Further research is needed to ensure patient safety during cardiac rehabilitation programs.
Area of Science:
- Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Several organizations provide risk stratification guidelines for supervised exercise in cardiovascular disease (CVD).
- These guidelines are intended to ensure patient safety during cardiac rehabilitation.
- The predictive accuracy of these guidelines for exercise complications remains unevaluated.
Purpose of the Study:
- To test the ability of existing risk stratification guidelines to predict complications during supervised exercise in CVD patients.
- To identify predictors of exercise complications in this population.
Main Methods:
- A prospective study evaluated 239 patients undergoing supervised outpatient cardiac rehabilitation exercise.
- Data included 5720 patient exercise hours and preprogram stress testing/left ventricular ejection fraction.
- Exercise complications were prospectively measured.
Main Results:
- Twelve complications occurred during supervised exercise.
- None of the four major guidelines accurately predicted complications (positive predictive values: 3-7%).
- Current cigarette smoking was the sole identified predictor of complications.
Conclusions:
- Existing exercise risk stratification guidelines do not reliably predict complications in CVD patients undergoing supervised exercise.
- Additional research is necessary before these guidelines can be used to determine eligibility for supervised services.
- Current smoking status is a significant risk factor for exercise complications.
Purpose:
Four authoritative organizations (American Association of Cardiovascular and Pulmonary Rehabilitation [AACVPR], the American College of Cardiology [ACC], the American College of Physicians [ACP], and the American Heart Association [AHA]) have risk stratification guidelines for supervised exercise in patients with cardiovascular disease. The ability of the guidelines to predict exercise complications is untested.
Methods:
A prospective sample was evaluated that included 239 patients enrolled for a total of 5720 patient exercise hours in a phase II supervised outpatient cardiac rehabilitation exercise program between December 1, 1992, and June 16, 1995, who had had preprogram stress testing and/or left ventricular ejection fraction determination. Complications during supervised exercise were measured.
Results:
Overall, 12 patients experienced complications during supervised exercise. None of the guidelines was predictive of complications (positive predictive values, 3-7%). Regression analyses demonstrated that current cigarette smoking was the only predictor of complications. There was reasonable correlation of patient risk stratification among the four guidelines (r = 0.19-0.47; P < 0.0001).
Conclusions:
Currently proposed exercise risk stratification guidelines are not predictive of complications during supervised exercise. Further work is needed before exercise risk stratification guidelines are used to adjudicate use of supervised services.