SPC365

The Role of Peak VO2 in Cardiac Rehabilitation: Predictors of non-response and their Impact on Long-Term Outcomes

Session: SESSÃO DE COMUNICAÇÕES ORAIS 17 - REABILITAÇÃO CARDÍACA: ESTRATIFICAÇÃO DE RISCO, IMPACTO DO EXERCÍCIO E O PAPEL DA EDUCAÇÃO NA MELHORIA DOS RESULTADOS DOS DOENTES
Speaker: Rita Figueiredo

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita M. Figueiredo; Miguel Raposo; Catarina Gregório; Ana Abrantes; Bruno Bento; Silvia Fiuza; Graça Araújo; Pedro Alves da Silva; Nelson Cunha; Inês Aguiar-Ricardo; Fausto J. Pinto; Ana Abreu

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The positive impact of cardiac rehabilitation in terms of improvement in functional capacity, quality of life, and prognosis is well established. However, not all patients respond adequately to the programs.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The objective of this work is to determine the rate and predictors of non-response to a cardiac rehabilitation program in terms of functional capacity.&nbsp; Additionally, it aims to evaluate the impact of non-response on prognosis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Prospective observational single-center study including patients enrolled in a phase II CR program between 2016 and 2024. Clinical, imaging, laboratory and CPET data were collected.The population was divided into two groups: responders and non-responders to the CR program. A responder was defined as someone who showed an improvement in peak VO2 of at least 1 ml/kg/min in the CPET after completing the program.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 236 patients completed a phase II CR program, of these 105 were non-responders to the CR program. The peak VO2 increased by 2,9 ml/kg/min (1,9-4,6) in the responders group compared to a decrease of 0,3 ml/kg/min (-2,15-0,2) in the non-responders group. The baseline walking test results were similar between the groups, but the responders group showed improvement at the end of the program (539m vs. 575m, p=0.03).&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Both groups were similar regarding baseline characteristics, except for the presence of diabetes, hypertension, age and BMI. In the non-responder group, the percentage of diabetics was higher (37% vs. 22%, p=0,02), as well hypertension (79.5% vs 56.5%, p=0.04). Non-responders were older (61.2&plusmn;0.9 years vs. 57.8&plusmn;1.2 years, p=0.024) and more obese (28.3&plusmn; vs 27.0&plusmn;, p=0.023).</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong> </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">There was a significant correlation between non-response to CR and diabetes (p=0.02), with a 52% probability of no improvement in peak VO2 among diabetics. Patients aged 62 or older demonstrated a statistically significant association with no improvement in peak VO2 (p = 0.024).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The mean follow-up time was 2.97 &plusmn; 1.69 years. Seven deaths were recorded and 12 hospitalizations. Non-responders reported a higher incidence of events and mortality compared to the responder group (1.4% vs. 1% for reinfarction, and 4% vs. 2% for deaths, respectively). A statistically significant correlation was observed between composite outcomes and a peak VO2 &le; 15 ml/kg/min (p = 0.02)</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Our findings highlight the importance of peak VO2 improvement in monitoring functional improvement during cardiac rehabilitation and its role in reducing events during follow-up. Diabetes and age were identified as predictors of non-improvement, emphasizing the need to enhance adherence and tailored interventions in these high-risk groups.</span></span></span></p>