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Updated: Sep 3, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac rehabilitation performance predicts 1-year major adverse cardiovascular events
Robert Naami1, Edmund Naami2, Tamer Omari3
1Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Patient exercise performance during cardiac rehabilitation predicts future cardiovascular events. A novel CR-score accurately identifies high-risk individuals for 1-year major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Preventive Cardiology
Background:
- Cardiac rehabilitation is crucial after major adverse cardiovascular events.
- Current data lacks correlation between rehabilitation performance and long-term outcomes.
Purpose of the Study:
- To determine if patient exercise performance during cardiac rehabilitation predicts future cardiovascular events.
- To introduce and validate a novel index, the CR-score, for assessing patient performance.
Main Methods:
- A single-center study of 486 patients in a cardiac rehabilitation program (January 2018 - August 2021).
- Performance assessed using the CR-score, integrating duration, speed, and workload on training devices.
- Cox regression analysis used to evaluate mortality rates in relation to major adverse cardiovascular events (MACE).
Main Results:
- 1-year MACE occurred in 5.5% of patients, significantly higher in those with prior cerebrovascular accident or transient ischemic attack.
- The median cumulative CR-score was significantly lower in patients who experienced MACE compared to controls.
- A CR-score of ≥1132 demonstrated high sensitivity (98.5%) and specificity (99.6%) for predicting 1-year MACE.
Conclusions:
- The developed CR-score accurately identifies patients at high risk for 1-year MACE post-cardiac rehabilitation.
- The CR-score offers a valuable tool for risk stratification in cardiac rehabilitation patients.
- Multicenter validation of the CR-score is recommended.
Background:
Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes.
Hypothesis:
Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events.
Methods:
We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group").
Results:
Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03).
Conclusion:
Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.
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