Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification Classification Tool Without Exercise Testing.
Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification Classification Tool Without Exercise Testing.
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DOI：
10.1097/hcr.0000000000000584
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发表时间：
2021-07-01
影响因子：
3.8
通讯作者：
Pack QR
中科院分区：
文献类型：
--
作者：
Bhat AG;Farah M;Szalai H;Lagu T;Lindenauer PK;Visintainer P;Pack QR
美国心血管和肺康复协会（AACVPR）建议开始心脏康复（CR）的患者进行分层，以确定运动相关不良事件（AE）的风险，但最近尚未对该工具进行评估。在2016年入组CR的患者中，我们使用AACVPR风险分层工具评估AE和临床事件（CE）的风险。我们将AE定义为CR期间排除或中断运动的体征或症状，CE定义为需要在CR运动课程之外进行紧急评估的事件。在研究期间，纳入了657例心血管诊断患者，并将其分类为高风险（58%），中等风险（31%）或低风险（11%）。在CR过程中（76天，17次），有63例AE和33例CE。不良事件大多是轻微的（没有心脏骤停或死亡），由CR工作人员管理。与低风险或中等风险组相比，高风险组更可能发生AE [HR 3.0，（95% CI，1.7- 5.9），P= .002]和CE [HR 3.7，（95% CI，1.5- 10.8），P = .002]，模型区分度良好[曲线下面积0.637，P <.001]。AACVPR风险分层工具可预测AE和CE，具有公平区分，尽管事件发生率较低且大多数为轻微事件。因此，AACVPR模型可能需要重新评估，以更好地识别真正存在重大AE风险的患者。在三级护理中心的一个队列中评价了美国心血管和肺康复协会风险分层工具，发现其对不良事件和临床事件具有公平的区分，但将患者过度分层为高风险组和中等风险组。
The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated. Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AEs and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions. During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared to the low or medium risk groups, the high-risk group was more likely to have AE [HR 3.0, (95% CI, 1.7- 5.9), P= .002], and CE [HR 3.7, (95% CI, 1.5- 10.8), P = .002] with fair model discrimination [area under the curve 0.637, P <.001]. The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE. The American Association of Cardiovascular and Pulmonary Rehabilitation risk stratification tool was evaluated in a cohort from a tertiary care center and noted to have fair discrimination for adverse and clinical events, but over-stratification of patients to high and medium risk groups.