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To be or not to be referred for cardiac rehabilitation after acute coronary syndrome
Referenciar ou não referenciar para reabilitação cardíaca após síndroma coronária aguda
Jorge Ferreira
Serviço de Cardiologia, Hospital de Santa Cruz – CHLO, Carnaxide, Portugal
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In a meta-analysis of 14<span class="elsevierStyleHsp" style=""></span>486 participants in 63 studies with a median follow-up of 12 months, CR led to reductions of 26% in cardiovascular mortality and 18% in the risk of hospital admissions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> This impact on the natural history of coronary atherothrombosis is due to the protective effects of exercise on lipid profile, blood pressure, inflammation and thrombogenic potential.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite their demonstrated and extensive benefits,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,7</span></a> exercise-based CR programs are clearly underused, due to patient-related, physician-related and health system-related factors.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In their study published in this issue of the <span class="elsevierStyleItalic">Journal</span>, Aguiar Rosa et al. assessed the predictors of improved functional capacity in 129 patients who participated in a CR program following ACS and who underwent cardiopulmonary exercise testing (CPET) at baseline and after 36 exercise training sessions.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Among CPET parameters, peak oxygen uptake (pVO<span class="elsevierStyleInf">2</span>) <20 ml/kg/min compared to pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min was associated with a significantly greater range of improvement in pVO<span class="elsevierStyleInf">2</span> (+4.4 vs. +1.6; p=0.018), in percentage of predicted pVO<span class="elsevierStyleInf">2</span> (+17.9% vs. +4.0%; p=0.009) and in pVO<span class="elsevierStyleInf">2</span> times systolic pressure at peak exercise (+883.3 vs. 238.5 mmHg.ml/kg/min; p=0.015) between baseline and after CR. Depressed or moderately impaired left ventricular ejection fraction was not associated with greater benefit from CR as assessed by improvement in functional capacity.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The rate of recurrence of major vascular events was low in a mean follow-up of five years, with annual mortality of 0.9% and annual ACS incidence of 1.2%. This may be explained by the good adherence to medical therapy, control of risk factors and adoption of healthier lifestyles in the study population.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The authors conclude that patients with poor functional capacity identified by CPET, which in their study represented 25% of a heterogeneous group of patients with ACS, will obtain the greatest benefit from CR. A referral strategy based on this parameter could help optimize use of CR facilities, which are in relatively short supply in Portugal.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferreira J. Referenciar ou não referenciar para reabilitação cardíaca após síndroma coronária aguda. Rev Port Cardiol. 2017;36:177–178.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Registry of Acute Coronary Syndromes: results of the hospital phase in 2002" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ferreira" 1 => "P. Monteiro" 2 => "J. 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| 2024 July | 33 | 29 | 62 |
| 2024 June | 29 | 17 | 46 |
| 2024 May | 27 | 22 | 49 |
| 2024 April | 32 | 26 | 58 |
| 2024 March | 24 | 37 | 61 |
| 2024 February | 23 | 45 | 68 |
| 2024 January | 30 | 38 | 68 |
| 2023 December | 17 | 26 | 43 |
| 2023 November | 21 | 17 | 38 |
| 2023 October | 20 | 15 | 35 |
| 2023 September | 16 | 22 | 38 |
| 2023 August | 26 | 15 | 41 |
| 2023 July | 20 | 11 | 31 |
| 2023 June | 23 | 12 | 35 |
| 2023 May | 34 | 20 | 54 |
| 2023 April | 17 | 15 | 32 |
| 2023 March | 24 | 22 | 46 |
| 2023 February | 27 | 15 | 42 |
| 2023 January | 20 | 13 | 33 |
| 2022 December | 39 | 18 | 57 |
| 2022 November | 31 | 21 | 52 |
| 2022 October | 32 | 18 | 50 |
| 2022 September | 24 | 28 | 52 |
| 2022 August | 20 | 29 | 49 |
| 2022 July | 22 | 27 | 49 |
| 2022 June | 14 | 18 | 32 |
| 2022 May | 21 | 27 | 48 |
| 2022 April | 20 | 21 | 41 |
| 2022 March | 19 | 22 | 41 |
| 2022 February | 25 | 30 | 55 |
| 2022 January | 26 | 27 | 53 |
| 2021 December | 17 | 27 | 44 |
| 2021 November | 35 | 35 | 70 |
| 2021 October | 38 | 47 | 85 |
| 2021 September | 27 | 24 | 51 |
| 2021 August | 27 | 27 | 54 |
| 2021 July | 18 | 21 | 39 |
| 2021 June | 23 | 24 | 47 |
| 2021 May | 19 | 36 | 55 |
| 2021 April | 37 | 63 | 100 |
| 2021 March | 72 | 18 | 90 |
| 2021 February | 41 | 17 | 58 |
| 2021 January | 39 | 16 | 55 |
| 2020 December | 24 | 15 | 39 |
| 2020 November | 34 | 14 | 48 |
| 2020 October | 28 | 17 | 45 |
| 2020 September | 76 | 16 | 92 |
| 2020 August | 8 | 10 | 18 |
| 2020 July | 36 | 14 | 50 |
| 2020 June | 37 | 14 | 51 |
| 2020 May | 30 | 3 | 33 |
| 2020 April | 24 | 5 | 29 |
| 2020 March | 31 | 14 | 45 |
| 2020 February | 49 | 25 | 74 |
| 2020 January | 26 | 5 | 31 |
| 2019 December | 26 | 5 | 31 |
| 2019 November | 22 | 11 | 33 |
| 2019 October | 33 | 2 | 35 |
| 2019 September | 21 | 11 | 32 |
| 2019 August | 35 | 5 | 40 |
| 2019 July | 37 | 10 | 47 |
| 2019 June | 30 | 17 | 47 |
| 2019 May | 45 | 9 | 54 |
| 2019 April | 20 | 16 | 36 |
| 2019 March | 67 | 15 | 82 |
| 2019 February | 41 | 12 | 53 |
| 2019 January | 40 | 3 | 43 |
| 2018 December | 22 | 7 | 29 |
| 2018 November | 65 | 15 | 80 |
| 2018 October | 147 | 18 | 165 |
| 2018 September | 38 | 13 | 51 |
| 2018 August | 56 | 20 | 76 |
| 2018 July | 29 | 3 | 32 |
| 2018 June | 50 | 8 | 58 |
| 2018 May | 40 | 9 | 49 |
| 2018 April | 50 | 4 | 54 |
| 2018 March | 60 | 6 | 66 |
| 2018 February | 26 | 4 | 30 |
| 2018 January | 27 | 10 | 37 |
| 2017 December | 55 | 3 | 58 |
| 2017 November | 66 | 12 | 78 |
| 2017 October | 36 | 8 | 44 |
| 2017 September | 43 | 11 | 54 |
| 2017 August | 41 | 14 | 55 |
| 2017 July | 43 | 17 | 60 |
| 2017 June | 56 | 19 | 75 |
| 2017 May | 48 | 18 | 66 |
| 2017 April | 55 | 22 | 77 |
| 2017 March | 50 | 22 | 72 |
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