title: The Value of Detecting Asymptomatic Signs of Myocardial Ischemia in Patients With Coronary Artery Disease in Outpatient Cardiac Rehabilitation.
abstract: BACKGROUND
  Electrocardiographic (ECG) monitored outpatient cardiac rehabilitation (OP-CR) is routinely performed following a variety of cardiovascular procedures and conditions.
  
  
  OBJECTIVE
  The aim of this study is to determine if diagnostic-quality ECG monitoring in patients with coronary artery disease (CAD) during OP-CR is useful in identifying asymptomatic myocardial ischemia, resulting in change(s) in care or medical management.
  
  
  METHODS
  A retrospective analysis of ECG monitoring was done on all OP-CR patients diagnosed with CAD (n = 1213) from January 2000 through June 2013.
  
  
  RESULTS
  Nearly a quarter of the patients (24%; n = 288) displayed at least 1 mm of asymptomatic ST-segment depression at 80 milliseconds after the J-point during at least 1 session of OP-CR. Of these patients, 57% had medical management change(s) compared with 24% for those who did not show ECG changes suggesting ischemia (P < .0001). In patients with asymptomatic ischemia having medical management change(s), 84% resulted directly from OP-CR staff detection. Fewer patients diagnosed with myocardial infarction and coronary artery bypass graft surgery demonstrated ECG signs of ischemia, whereas more patients diagnosed with stable angina and percutaneous coronary interventions demonstrated ECG signs of ischemia.
  
  
  CONCLUSIONS
  This study demonstrates that most patients with CAD showing asymptomatic ECG signs suggesting ischemia undergo medical management change(s) as a result of the finding. Diagnostic-quality ECG monitoring during OP-CR appears warranted in this population.
authors.affiliation: Patricia Lounsbury, RN-BC, BSN, MEd, Alumnus CCRN, FAACVPR Formerly with (Program Director) Cardiovascular Health, Assessment, Management, and Prevention Services (CHAMPS), University of Iowa Health Care. Ahmed S. Elokda, PT, PhD, CLT, CEEAA, FAACVPR Associate Professor, Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, and Professor, Department of Physical Therapy, Cairo University, Cairo, Egypt. Jennifer M. Bunning, BA, ACSM cPT Cardiac Rehabilitation Specialist, Cardiovascular Health, Assessment, Management, and Prevention Services, University of Iowa Health Care. Ross Arena, PT, PhD, FAHA, FESC, FESPN, FAACVPR Professor and Department Head, Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois, Chicago. Ellen E. I. Gordon, MD, FACC Formerly with Department of Internal Medicine, Professor Emeritus, University of Iowa Health Care.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lounsbury
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Elokda
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bunning
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Ellen E I
authors.initials: EE
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000072038:Cardiac Rehabilitation; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult