Article

There is evidence of substantial benefit of cardiac rehabilitation (CR) for
patients with low exercise capacity at admission. Nevertheless, some patients are
not able to perform an initial exercise stress test (EST). We aimed to describe
this group using data of 1094 consecutive patients after a cardiac event (71+/-7
years, 78% men) enrolled in nine centres for inpatient CR. We analysed
sociodemographic and clinical variables (e.g. cardiovascular risk factors,
comorbidities, complications at admission), amount of therapy (e.g. exercise
training, nursing care) and the results of the initial and the final 6-min
walking test (6MWT) with respect to the application of an EST. Fifteen per cent
of patients did not undergo an EST (non-EST group). In multivariable analysis,
the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89,
P=0.01], a 6MWT (per 10 m, OR 1.07, P<0.01) and lower for patients with diabetes
mellitus (OR 0.48, P<0.01), NYHA-class III/IV (OR 0.27, P<0.01), osteoarthritis
(OR 0.39, P<0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The
non-EST group received fewer therapy units of exercise training, but more units
of nursing care and physiotherapy than the EST group. However, there were no
significant differences between both groups in the increase of the 6MWT during CR
(123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at
the start of CR as an indicator of disease severity. Nevertheless, patients
without EST benefit from CR even if exercising less. Thus, there is a justified
need for individualized, comprehensive and interdisciplinary CR.

Langue : ANGLAIS