title: Identifying patients at low risk for activity-related events: the RARE Score.
abstract: OBJECTIVE
  To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately identifies patients who are at low risk of experiencing an adverse event while exercise training at cardiac rehabilitation.
  
  
  METHODS
  Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score < 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented.
  
  
  RESULTS
  Individuals (n = 656) were eligible for analysis (high risk: n = 260; low risk: n = 396). Eleven events (1 major, 10 minor) were recorded during the study, and the overall event rate was low (1 event per 1321 patient hours of exercise training). Individuals triaged as high-risk had significantly more events than the low-risk cohort (high risk: n = 8 vs low risk: n = 3; P = .024) and were 4 times more likely to experience an adverse event (OR: 4.2; 95% CI: 1.0-20.0). More than 99% of low-risk patients were event free (negative predictive value: 99.2%; 95% CI: 98.3-99.8), while participating in exercise at cardiac rehabilitation.
  
  
  CONCLUSIONS
  The RARE Score accurately identifies patients who are at low risk of experiencing adverse events during exercise training at cardiac rehabilitation. The identification of low-risk patients allows for the possibility of reduced on-site supervision and monitoring, or the provision of alternative models of cardiac rehabilitation, including community- or home-based cardiac rehabilitation programs.
authors.affiliation: Queen's University, Kingston, Ontario, Canada (Messrs Lacombe and Ball); Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada (Dr LaHaye and Ms Hopkins-Rosseel); and Royal Alexandra Hospital, Queen's University, Edmonton, Alberta, Canada (Ms Lau).
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Lacombe
authors.forename: Stephen A
authors.initials: SA
authors.lastname: LaHaye
authors.forename: Diana
authors.initials: D
authors.lastname: Hopkins-Rosseel
authors.forename: David
authors.initials: D
authors.lastname: Ball
authors.forename: Winnie
authors.initials: W
authors.lastname: Lau
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D003955:Diagnostic Tests, Routine; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D014218:Triage; D014693:Ventricular Fibrillation / Q000453:epidemiology