title: Prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation.
abstract: 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.
authors.affiliation: Cardiovascular Rehabilitation, Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Valentino
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.forename: Sabina
authors.initials: S
authors.lastname: Jaggi
authors.forename: Jörg
authors.initials: J
authors.lastname: Schumann
authors.forename: Karin
authors.initials: K
authors.lastname: Sommerfeld
authors.forename: Simone
authors.initials: S
authors.lastname: Piazzalonga
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoffmann
mesh_terms: 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
chemical_list: D002121:Calcium Channel Blockers