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An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac

Felipe Ribeiro1, Carolina Takahashi1, Lais Manata Vanzella1

  • 1Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil.

Clinical Rehabilitation
|December 9, 2020
PubMed

Insights

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a significant link between risk classes and minor complications in cardiac rehab. However, its low accuracy indicates it is not effective for this purpose.

Area of Science:

  • Cardiology
  • Rehabilitation Medicine
  • Clinical Risk Stratification

Background:

  • Cardiovascular rehabilitation programs aim to manage patients with cardiovascular disease.
  • Effective risk stratification is crucial for patient safety during rehabilitation.
  • Evaluating existing protocols for their ability to predict minor complications is essential.

Purpose of the Study:

  • To assess the efficacy of seven cardiac risk stratification protocols in predicting simple complications during cardiovascular rehabilitation.
  • To determine if protocols like AACVPR, ACSM, and others can identify patients at risk for adverse events.

Main Methods:

  • An observational longitudinal cohort study was conducted in an outpatient cardiovascular rehabilitation clinic.
  • Seventy-six patients with cardiovascular disease or risk factors were analyzed.
  • The chi-square test was used to assess the relationship between risk classes and complications, followed by sensitivity, specificity, and accuracy calculations.

Main Results:

  • The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol demonstrated a statistically significant relationship (P=0.046) between risk classes and simple complications.
  • However, the AACVPR protocol yielded low sensitivity (0.53), specificity (0.52), and accuracy (0.53).
  • All other evaluated protocols (ACSM, SBC, AHA, Pashkow, SFC, SSC) showed no statistically significant relationship with complications.

Conclusions:

  • While the AACVPR protocol showed a significant association, its poor performance metrics (sensitivity, specificity, accuracy) render it unsuitable for predicting simple complications in cardiovascular rehabilitation.
  • Further research may be needed to develop or refine risk stratification tools for this clinical setting.
Abstract

Keywords:
Cardiac rehabilitationcardiac eventscardiac riskclinical protocolssignals and symptoms

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