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Enhancing Functional Risk Stratification in Contemporary Cardiac Rehabilitation

Garrett Kellar,K. Allsup,Amanda Delligatti,A. Althouse,D. Forman

Published 2020 in Journal of Cardiopulmonary Rehabilitation and Prevention

ABSTRACT

Supplemental Digital Content is Available in the Text. Risk stratification (RS) in cardiac rehabilitation (CR) relies primarily on metrics of cardiovascular disease (CVD). We stratified patients enrolling into phase II CR into function-based RS versus CVD-based RS. Functional risks often exist in the absence of CVD risks, suggesting that there are important opportunities to tailor and improve CR management. Purpose: Current American Association of Cardiovascular and Pulmonary Rehabilitation guidelines rely primarily on cardiovascular disease (CVD)-centered metrics to stratify risk and guide care. Yet, contemporary CVD patients are often older and are more likely to have risks attributable to rudimentary functional impairments that can have disproportionate bearing on management and prognosis. In this study, we stratified risk using novel indices of physical function as well as traditional indices of CVD in patients enrolling in phase II cardiac rehabilitation (CR). We hypothesized that risk stratification (RS) using functional criteria would be nonconcordant with CVD RS in a significant number of patients, thus inferring the conceptual value of CR management priorities that are better tailored for distinctive functional risks in many patients. Methods: This was a retrospective analysis of a comprehensive quality improvement database with 489 patients. Risk stratification using novel functional indices (ie, gait speed, Timed Up and Go, hand grip, sit to stand, tandem stand, and a 6-min walk test) was compared with RS using traditional CVD criteria. Results: Using functional RS, 97 patients were determined to be high risk versus 235 at low risk. Using CVD RS in the same cohort, 227 patients had high risk versus 161 who had low risk. Functional RS was consistent with CVD RS only 42.9% of the time. Conclusion: Functional RS and CVD RS varied in the same patients. Enhanced assessment of functional risks adds important prognostic refinement and greater potential to tailor exercise therapy, nutrition, and other CR caregiving priorities.

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