DEVELOPMENT OF A NEW CARDIAC RISK STRATIFICATION SCORE FOR EXERCISE BASED CARDIAC REHABILITATION PATIENT SCREENING

Cardiac risk stratification is essential for cardiac rehabilitation; however, current protocols have some or no relationship with the occurrence of acute events during exercise. PURPOSE: To develop a new risk stratification tool for predicting simple acute events during exercise. METHODS: Longitudinal observational study that followed 73 participants of a cardiac rehabilitation program for 2 months to record acute complications triggered by exercise (angina, muscle pain, dizziness, changes in systolic pressure, and fatigue). Before the follow-up period, the volunteers were evaluated regarding lung function (spirometry and manovacuometry), body composition (bioimpedance), functional capacity (6-Minute Walk test), and peripheral muscle strength (Quadriceps dynamometry). For all variables, a cutoff value was defined to act as stratification criteria and their predictive power was evaluated using binary logistic regression and ROC curve (P < 0.05). RESULTS: Functional capacity (OR: 4.3 - p: 0.017) is related to the occurrence of ≥1 event; maximum expiratory pressure with ≥2 events (OR: 6.7 - p: 0.004); body mass index - BMI (OR: 3.4 - p: 0.027), corporal adiposity index (OR: 5.4 - p: 0.002), forced exhaled volume in the 1st second - (OR: 4.2 - p: 0.004), and forced vital capacity - FVC (OR: 8.1 - p: 0.007) with ≥3 events; percentage of body fat (OR: 8.9 - p: 0.002), muscle strength (OR: 5.3 - p: 0.032) and the percentage obtained in relation to the predicted FVC (OR: 6.0 - p: 0.013) with ≥6 events. Only the BMI, muscle strength and FVC did not obtain acceptable accuracy values (≥0.7). A score was attributed for each variable based on the regression coefficient (b1) multiplied by 1 if the variable was related to the occurrence of at least 1 event, by 2 if related to at least 3 events, and by 3 if related to at least 6 events. Based on the sum of each variable score the risk class is defined separately for males (Low <32.2; High: ≥42.0) and females (Low: <38.9; High: ≥ 45.1). CONCLUSIONS: The developed tool can be useful for estimating the risk of simple acute events occurring in cardiac rehabilitation through a score composed of variables of functional capacity, lung function, and body composition of easy and cheap assessment. FAPESP grant number 2020/16551-0