Prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation.
BACKGROUND
The prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation (OCR) is not well established.


METHODS
2146 consecutive patients undergoing symptom-limited cycle exercise testing at OCR entry, of whom 1853 (86%) also had a test at end of OCR, were followed for a median of 33 months.


RESULTS
All-cause and cardiovascular annual mortality rates were 1.2% and 0.8%, respectively. At OCR entry, older age, diabetes, lower left ventricular ejection fraction (LVEF), calcium channel blocker use, and lower workload [hazard ratio (HR) 2.38 if < or = 105 W; p<0.001] were independent predictors of death. Diabetes, diuretic use, and lower workload [HR 3.53 if < or = 105 W; p=0.001] were independently associated with cardiovascular death. At end of OCR, older age, lower LVEF, lower workload (HR 2.34 if <140 W; p=0.009), and lower increase in peak heart rate from entry to end of OCR (HR 2.46 if <4 bpm; p=0.002) were independently associated with all-cause mortality. Older age, lower LVEF, lower increase in systolic blood pressure (HR 2.97 if <54 mm Hg; p=0.02), and lower increase in peak heart from entry to end of OCR (HR 2.72 if <4 bpm; p=0.013) were independently associated with cardiovascular mortality. Failure to undergo a test at end of OCR was an additional independent predictor of all-cause (HR 2.51; p<0.001) and cardiovascular mortality (HR 2.56; p=0.003).


CONCLUSIONS
Symptom-limited cycle exercise testing prior to and after OCR provides important prognostic information.
Di Valentino
Marcello
M
Cardiovascular Rehabilitation, Department of Cardiology, University Hospital, Basel, Switzerland.
Maeder
Micha T
MT
Jaggi
Sabina
S
Schumann
Jörg
J
Sommerfeld
Karin
K
Piazzalonga
Simone
S
Hoffmann
Andreas
A
D000553:Ambulatory Care; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005080:Exercise Test; D017079:Exercise Tolerance; D006331:Heart Diseases / Q000401:mortality* / Q000503:physiopathology / Q000534:rehabilitation*; D006339:Heart Rate; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies
D002121:Calcium Channel Blockers