Cardiac rehab score predicts event risk at 1 year
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Exercise performance during cardiac rehabilitation, scored with a novel index, can reliably predict CV event risk at 1 year, according to data from a single-center study.
“Participating in a cardiac rehabilitation program is essential to improving patients' survival and quality of life following myocardial infarction or heart surgery and for patients with HF,” Ofir Koren, MD, FESC, an interventional cardiology fellow with the Cedars-Sinai Medical Center Smidt Heart Institute and a senior interventional cardiologist with Emek Medical Center in Afula, Israel, told Healio. “Our study supports previous evidence and emphasizes the importance of understanding the level of endurance required to promote improved outcomes by designing a simple-to-use formula that can guide physicians and physiotherapists toward a target-directed program.”
Koren and colleagues analyzed data from 486 adults who participated in at least 80% of sessions in a cardiac rehabilitation program between January 2018 and August 2021 at Emek Medical Center in Israel. The rehab program is a twice weekly, 3-month government-funded program; each session includes exercises on a treadmill, elliptical, bicycle and handcycle. Researchers assessed patient performance using a novel index, the “CR score,” which integrated duration, speed of work and workload conducted on each training device. Researchers then determined the optimal thresholds for a cumulative CR score and assessed the mortality rate among patients who developed a major adverse CV event and those who did not (controls).
The findings were published in Clinical Cardiology.
Major adverse CV events occurred in 5.5% of patients at 1 year; events were more common among those with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%; P < .001). Age, sex, comorbidities, HF and medical treatment did not affect the outcome.
The median cumulative CR score of the study group was lower compared with controls (median, 595 vs. 3,500; P < .0001). A cumulative CR score of greater than 1,132 correlated with the outcome with 98.5% sensitivity and 99.6% specificity (95% CI, 0.9850.997; P < .0001). Patients older than age 55 years with a cumulative CR score of greater than 1,132 were deemed at highest risk for a major adverse CV event at 1 year, with an OR of 7.4 (95% CI, 2.84-18.42); Kaplan-Meier survival curve indicated that major adverse CV events at 1 year occurred much earlier among patients with a low CR score (log-rank P = .03).
The researchers noted that the CR score is a novel score that has not been validated on a large scale.
“These data may assist physicians and physiotherapists in tailoring a specific CR program with clear physical targets,” Koren, also a clinic lecturer at Technion University in Israel, told Healio. “We need a prospective study involving two groups randomly assigned to two therapeutic options — current CR practice and a CR program directed using our model.”
For more information:
Ofir Koren, MD, FESC, can be reached at ofir.koren@cshs.org; Twitter: @dr_ofir.
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