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

OBJECTIVES: This study evaluated the capacity of cardiac risk stratification protocols on simple complications that occur during activities of a cardiovascular rehabilitation program. DESIGN: Observational longitudinal cohort study. SETTING: Outpatient clinic of cardiovascular rehabilitation. SUBJECT: Patients diagnosed with cardiovascular disease and/or risk factors. INTERVENTIONS: Not applicable. MAIN MEASURES: The relationship between the cardiac risk classes of seven risk stratification protocols and the occurrence of simple complications (such angina, abnormal changes in blood pressure, arrhythmias, fatigue, muscle pain, pallor) was assessed using the chi-square test, and when statistical significance was observed, sensitivity, specificity and accuracy were determined. RESULTS: About 76 patients were analyzed. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a statistically significant relationship between simple complications and cardiac risk classes (P-value = 0.046), however the results of sensitivity (0.53), specificity (0.52), and accuracy (0.53) were not significant. The other protocols analyzed were not significant: American College of Sports Medicine (P-value = 0.801), Brazilian Society of Cardiology (P-value = 0.734), American Heart Association (P-value = 0.957), Pashkow (P-value = 0.790), Society French Cardiology (P-value = 0.314), and Spanish Society of Cardiology (P-value = 0.078). CONCLUSION: The AACVPR protocol showed a significant relationship between the risk classes and the occurrence of simple complications, however, the low values obtained for sensitivity, specificity and accuracy show that it is not useful for this purpose. CLINICAL TRIALS REGISTRATION: NCT03446742.

Are signs and symptoms in cardiovascular rehabilitation correlated with heart rate variability? An observational longitudinal study.

AIM: To analyze the correlation between the appearance of signs/symptoms during a cardiovascular rehabilitation program and linear indexes of the heart rate variability (HRV) at rest. METHODS: To carry out the present observational longitudinal study, 48 patients were analyzed. The protocol was divided into two stages. First, the patients had their personal details collected, and the autonomic modulation at rest was evaluated by HRV. Second, they underwent 36 sessions of the cardiovascular rehabilitation program to evaluate signs/symptoms. Then, just for analysis of the data, they were divided into two groups: the group without signs/symptoms (n = 26; 65.15 ± 9.7 years); and the group with signs/symptoms (n = 22; 66.77 ± 14.4 years). The HRV indexes were compared by ancova. The effect size was measured through the partial eta-squared. Pearson's and Spearman's correlations (P < 0.05) were used to analyze the data, and linear regression was applied. RESULTS: A total of 103 signs/symptoms occurred. The group with signs/symptoms presented lower values of HRV indexes when compared with the group without signs/symptoms, especially for the parasympathetic indexes with a large effect size. The root mean square of successive differences (rMSSD), percentage of adjacent RR intervals with a difference of duration >50 ms (pNN50), high-frequency spectral component (HF) varying from 0.15 to 0.4 Hz (expressed as ms2 ), dispersion of the points perpendicular to the line of identity and represents the instantaneous record of the beat-to-beat variability (SD1) and SD1/scatter of points along the identity line and represents the HRV in long-term records (SD2) index presented a negative correlation with the appearance of signs/symptoms. When the linear regression was applied, the rMSSD, SD1 and SD1/SD2 showed negative values of ß (P < 0.05). CONCLUSIONS: Patients with lower HRV are more likely to have signs/symptoms. The rMSSD, pNN50, HF (expressed as ms2 ), SD1 and SD1/SD2 index presented a negative correlation with the appearance of signs/symptoms. For rMSSD, SD1 and SD1/SD2, the lower the values of these HRV indexes, the greater the risk of appearance of signs/symptoms. Geriatr Gerontol Int 2020; 20: 853-859.

Efficacy of risk stratification protocols and clinical, physical, and biochemical parameters to previse signals and symptoms during cardiovascular rehabilitation programs: Protocol for an observational trial.

INTRODUCTION: Despite the benefits, cardiovascular rehabilitation programs (CRPs) have been related to the appearance of signals and symptoms. Risk stratification protocols are commonly used to identify risks during the physical exercise; however, studies that investigate their efficacy to previse signals and symptoms are inconclusive. Furthermore, clinical, physical, and biochemical parameters have been used as risk markers for the appearance of adverse events, and to investigate their efficacy to previse signals and symptoms during the CRP sessions that could better guide the strategies adopted on these programs. OBJECTIVES: The aim of this study was to evaluate the correlations between risk stratification protocols and clinical, physical, and biochemical parameters with the appearance of signals/symptoms during CRP, as well as to evaluate if modifications on clinical, physical, and biochemical parameters could influence in the appearance of signals/symptoms during CRP. MATERIALS AND METHODS: The study was prospectively registered at ClinicalTrials.gov (NCT03446742). Forty-four patient participants of a CRP will be evaluated. First, their risk stratification is going to be performed by 2 evaluators and their clinical, physical, and biochemical parameters are going to be measured. Then, the patients are going to be followed during 24 sessions during their CRP routines in order to identify appearance of their signals/symptoms. So, the patients are going to perform their cardiovascular rehabilitation routines for 6 months and then, their clinical, physical, and biochemical parameters are going to be measured again and they are going to be followed during 24 sessions during their CRP routines in order to identify the appearance of their signals/symptoms.