Abstract
Background
We aimed to determine and compare predictors of postcardiac rehabilitation (CR) cardiorespiratory
fitness (CRF), improvements in a large cohort of subjects with varying baseline CRF
levels completing CR for ischemic heart disease and to refine prediction models further
by baseline CRF.
Methods
The Alberta Provincial Project for Outcomes Assessment in Coronary Heart disease (APPROACH) and TotalCardiology (TotalCardiology, Inc, Calgary, Alberta,
Canada) databases were used retrospectively to obtain information on 10,732 (1955
[18.2%] female; mean age 60.4, standard deviation [SD] 10.5 years) subjects who completed
the 12-week comprehensive CR program between 1996 and 2016. Peak metabolic equivalents
(METs) were determined at program start and completion and identified patients at
baseline with low fitness (L-Fit) (< 5 METs), moderate fitness (M-Fit, 5-8 METs),
or high fitness (H-Fit, > 8 METs). Multivariable linear regression models were developed
to predict METs at completion of the program.
Results
Across all fitness groups, mean baseline METs was the strongest predictor of CRF at
completion of CR. Other factors—including sex, age, current smoking status, obesity,
and diabetes—were highly predictive of post-CR CRF (all P < 0.05). Compared with H-fit patients, coronary artery bypass graft and chronic obstructive
pulmonary disease in L-Fit patients, and cerebrovascular disease in M-Fit patients
had an additional negative effect on the overall model variance in post-CR CRF.
Conclusion
Expected CRF at the end of CR is highly predictable, with several key patient factors
being clear determinants of CRF. Although most identified patient factors are not
modifiable, our analysis highlights populations that may require extra attention over
the course of CR to attain maximal benefit.
Résumé
Introduction
L’objectif de cette étude était de recenser et de comparer les prédicteurs de la capacité
cardiorespiratoire (CCR) après une réadaptation cardiaque (RC), de mesurer les améliorations
observées dans une large cohorte de sujets présentant des niveaux variables de CCR
initiale suivant un programme de RC en raison d’une cardiopathie ischémique et de
préciser les modèles prédictifs en fonction de la CCR initiale.
Méthodologie
Nous avons utilisé les bases de données APPROACH (Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease) et TotalCardiology (TotalCardiology, Inc, Calgary, Alberta, Canada) de façon rétrospective
afin d’obtenir de l’information sur 10 732 sujets (dont 1955 [18,2 %] femmes; âge
moyen de 60,4 ans, écart-type [E.-T.] 10,5 ans) ayant suivi le programme complet de
RC de 12 semaines entre 1996 et 2016. L’équivalent métabolique maximum (MET) a été
déterminé au début et à la fin du programme et les patients ont été caractérisés selon
que leur capacité initiale était faible (Cap-F, < 5 MET), modérée (Cap-M, de 5 à 8
MET) ou élevée (Cap-E, > 8 MET). Des modèles de régression linéaire multivariée ont
été élaborés pour prédire la valeur du MET à la fin du programme.
Résultats
Dans tous les groupes par niveau de capacité, le MET initial moyen était le facteur
prédictif le plus puissant de la CCR à l’issue de la RC. D’autres facteurs, notamment
le sexe, l’âge, les habitudes actuelles en matière d’usage du tabac, l’obésité et
le diabète étaient de puissants facteurs prédictifs de la CCR post-RC (toutes les
valeurs P < 0,05). Comparativement aux patients de niveau Cap-E, le pontage aortocoronarien
et la maladie pulmonaire obstructive chronique chez les patients Cap-F et la maladie
vasculaire cérébrale chez les patients Cap-M avaient un effet négatif additionnel
sur la variance du modèle global pour la CCR post-RC.
Conclusion
La CCR attendue à la fin de la RC est hautement prédictible et plusieurs facteurs
clés propres au patient sont des déterminants majeurs de ce paramètre. Si la plupart
des facteurs propres au patient recensés ne sont pas modifiables, notre analyse met
cependant en lumière certaines populations qui peuvent nécessiter une attention particulière
tout au long de la RC pour lui permettre de tirer un avantage maximum d’un tel programme.
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Article info
Publication history
Published online: March 29, 2018
Accepted:
March 26,
2018
Received:
February 7,
2018
Footnotes
See editorial by Tucker and Haykowsky, pages 819–820 of this issue.
See page 931 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Predictors of Cardiorespiratory Fitness Improvements With Cardiac Rehabilitation: Lower Baseline Fitness With the Most to Gain, Gains the MostCanadian Journal of CardiologyVol. 34Issue 7
- PreviewCardiorespiratory fitness (CRF), measured as peak metabolic equivalents (METs) estimated during a symptom-limited exercise test, is a major independent predictor for all-cause mortality in healthy individuals and patients with coronary artery disease (CAD).1,2 Comprehensive cardiac rehabilitation (CR)—consisting of medical evaluation, exercise training, cardiac risk- factor modification, nutrition counseling, and stress management—is an effective therapeutic intervention to reduce mortality, morbidity, and hospitalization in patients with CAD.
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