Guías de práctica clínica de la Sociedad Española de Cardiología sobre la actividad física en el cardiópata

An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac rehabilitation programs?

OBJECTIVES

This study evaluated the capacity of cardiac risk stratification protocols on simple complications that occur during activities of a cardiovascular rehabilitation program.

DESIGN

Observational longitudinal cohort study.

SETTING

Outpatient clinic of cardiovascular rehabilitation.

SUBJECT

Patients diagnosed with cardiovascular disease and/or risk factors.

INTERVENTIONS

Not applicable.

MAIN MEASURES

The relationship between the cardiac risk classes of seven risk stratification protocols and the occurrence of simple complications (such angina, abnormal changes in blood pressure, arrhythmias, fatigue, muscle pain, pallor) was assessed using the chi-square test, and when statistical significance was observed, sensitivity, specificity and accuracy were determined.

RESULTS

About 76 patients were analyzed. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a statistically significant relationship between simple complications and cardiac risk classes (P-value = 0.046), however the results of sensitivity (0.53), specificity (0.52), and accuracy (0.53) were not significant. The other protocols analyzed were not significant: American College of Sports Medicine (P-value = 0.801), Brazilian Society of Cardiology (P-value = 0.734), American Heart Association (P-value = 0.957), Pashkow (P-value = 0.790), Society French Cardiology (P-value = 0.314), and Spanish Society of Cardiology (P-value = 0.078).

CONCLUSION

The AACVPR protocol showed a significant relationship between the risk classes and the occurrence of simple complications, however, the low values obtained for sensitivity, specificity and accuracy show that it is not useful for this purpose.

CLINICAL TRIALS REGISTRATION

NCT03446742.

Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial

BACKGROUND

Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk.

METHODS

A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life.

RESULTS

No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme.

CONCLUSIONS

The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life.

TRIAL REGISTRATION

Retrospectively registered NCT02796404 (May 23, 2016).

Usefulness of echocardiography in preparticipation screening of competitive athletes

INTRODUCTION AND OBJECTIVES

Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes.

METHODS

Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography.

RESULTS

A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardiography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring.

CONCLUSIONS

Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes.

Morte súbita em atletas: protocolos e rotinas adotados por clubes de futebol profissional em São Paulo

A morte súbita cardíaca em atletas não é um fato novo e nem isolado. Historicamente, ela atinge principalmente atletas jovens, tendo como maior incidência a cardiomiopatia hipertrófica. No ano de 2005, a Sociedade Brasileira de Medicina do Esporte instituiu a Diretriz sobre a Morte Súbita no Exercício e no Esporte. A implementação dessas recomendações por clubes de futebol profissional poderá contribuir para detecção precoce de risco e prevenção de morte súbita nesses atletas. OBJETIVO: Identificar a adoção de protocolos e rotinas por clubes de futebol profissional quanto à avaliação pré-participação dos atletas e sua adequação à Diretriz. MÉTODO: Todos os clubes de futebol profissional do município de São Paulo pertencentes à Federação Paulista de Futebol foram avaliados através de entrevista com o médico responsável pelo Departamento Médico de cada clube, após aprovação do projeto pelo Comitê de Ética em Pesquisa e autorização do sujeito de pesquisa. As respostas foram submetidas à estatística descritiva e comparadas à Diretriz. RESULTADOS: Nenhum clube adota integralmente os exames sugeridos pela Diretriz; contudo, os exames como anamnese completa com enfoque cardiovascular, teste ergométrico e eletrocardiograma de repouso são realizados por todos. O ecocardiograma é realizado por 82,5% dos clubes. CONCLUSÃO: Todos os clubes avaliados seguem um protocolo institucional que contempla parcialmente as recomendações da Diretriz. Sugere-se a integração entre os órgãos responsáveis pelo esporte no Brasil e parcerias privadas com o objetivo de diminuir o custo efetivo dos exames