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Predictors of non-response to cardiac rehabilitation program
Session:
CO 04 - Reabilitação Cardíaca
Speaker:
Marta Fontes Oliveira
Congress:
CPC 2018
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Marta Fontes Oliveira; Maria Trêpa; Raquel Baggen Santos; Inês Silveira; Ana Barreira; Preza Fernandes; Mário Silva Santos; Sofia Cabral; Sandra Magalhães; Severo Torres
Abstract
<p>INTRODUCTION: The improvement of functional capacity (FC) after cardiac rehabilitation program (CRP) is associated with a better prognosis, particularly after acute myocardial infarction (AMI). Identifying those patients who are more likely to fail to improve FC would allow a tailored optimized intervention. The aim of this study was to determine the clinical predictors of the non-responders to a CRP.</p> <p>METHODS: We studied 1017 patients with ischaemic cardiomyopathy who completed a CRP between 2011 and 2017. Patients underwent a supervised exercise training protocol, twice a week during a period of 8-12 weeks. Functional capacity was evaluated by metabolic equivalents (METs) assessed prior the beginning and 3 months after the program with a symptom limited exercise treadmill test. Non-responders were defined if patients failed to increased FC in more than 10% at the end of 3 months.</p> <p>RESULTS: Of 1017 patients that completed the program, 801 (78.8%) were male and most of them were admitted after an AMI (n=798, 78,5%). Thirty four percent (n=349) of the patients were considered non-responders. Responders and non-responders had a mean change of FC of 2.06±0.94 and 0.24±0.72 METs, respectively. Non-responders were younger (59.3±11.1 vs 60.7±10.1 years, p=0.045) and had a better FC in the beginning of CRP (9.47±2.23 vs 7.92±2.19 METs, p<0.0001). Smoking history was also associated to non-responder status (41.5% vs. 33.0%, p=0.014). Sex, central obesity, diabetes, left ventricular function, reason for referral to the CRP (AMI vs stable coronary artery disease) and physical activity level did not predict change in FC. During a mean follow-up of 9.5±4.0 months, 3 patients died and 1 suffered an AMI - there was no association between these events and FC response.</p> <p>CONCLUSION: Younger and more fitted patients are those associated with a lack of FC improvement after a CRP. Whether this FC response pattern has prognostic significance is unknown but critically important to tailor cardiac rehabilitation interventions.</p>
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