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Phase 2 Cardiovascular Rehabilitation: A Study on Population Profiles and Outcomes
Session:
SESSÃO DE POSTERS 03 - REABILITAÇÃO CARDÍACA AO LONGO DO CONTINUUM DE CUIDADOS - DA PREVENÇÃO AOS RESULTADOS A LONGO PRAZO
Speaker:
Nuno Alexandre Dias Madruga
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Cartazes
FP Number:
---
Authors:
Nuno Madruga; Miguel Raposo; Bruno Bento; Sílvia Fiúza; Daniela Roxo; Pedro Alves da Silva; Nelson Cunha; Inês Aguiar Ricardo; Fausto J. Pinto; Ana Abreu
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Introduction:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Phase II cardiac rehabilitation (CR) programs, integrating exercise, education, and multidisciplinary care, play a key role in improving outcomes for cardiovascular patients. However, the impact on cardiorespiratory test (CPET) and long-term clinical results remains underexplored.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Purpose:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">To evaluate the impact <span style="color:black">of a phase II CR program on CPET parameters, cardiovascular risk factors</span> <span style="color:black">and clinical outcomes.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Methods: </span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Prospective observational single-center study including patients enrolled in a phase II CR program between 2016 and 2024. The program involved assessments by cardiologists, nutritionists and psychologists, with supervised exercise sessions twice a week and educational sessions. Parametric and non-parametric tests were performed as appropriate.</span></span></span> </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">A total of 550 patients (80% male, mean age 63.3 ± 11 years) completed a phase II cardiac rehabilitation (CR) program. The majority had ischemic cardiomyopathy (83%), followed by valvular (11%) and dilated cardiomyopathy (6%). Among coronary artery disease patients, 49% had multivessel disease and 29% had incomplete revascularization. Common comorbidities included hypertension (70%), dyslipidemia (71.5%), smoking (63%), diabetes (27.3%) and chronic kidney disease (21%). At baseline, 50% of patients were in NYHA class II, 34% in class I, and 16% in class III. The median NT-proBNP was </span></span></span><span style="font-size:10.0pt"><span style="font-family:"Trebuchet MS",sans-serif">456 (186-1072)<span style="color:black"> pg/ml</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> and 20% had LVEF <40%. Patients attended an average of 14 CR sessions (92% of scheduled sessions).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Following the CR program, statistically significant improvements in CPET were observed: VO2 peak increased from 15.6 ± 0.3 to 17.0 ± 0.3 mL/kg/min (p < 0.01), % predicted VO2 peak increased from 62.2 ± 1.1 to 68.0 ± 1.1 (p < 0.01), PETCO2 improved from 33.6 ± 0.3 to 34.4 ± 0.3 (p < 0</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">.<span style="color:black">01), circulatory power increased from 2661 ± 72.1 to 2896 ± 79 (p < 0.01), and the VE/VCO2 slope decreased from 32.2 ± 0.5 to 30.7 ± 0.4 (p < 0.01).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">There was also a statistically significant improvement in cardiovascular risk factor control. Total cholesterol decreased (median 151 to 138 mg/dL</span></span></span> <span style="font-family:"Calibri",sans-serif">p<0.01</span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">), LDL cholesterol dropped (median 90 to 63 mg/dL, </span></span></span><span style="font-family:"Calibri",sans-serif">p<0.01</span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">), triglycerides declined (median 110 to 99 mg/dL, </span></span></span><span style="font-family:"Calibri",sans-serif">p<0.01</span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">) and HbA1c improved (6.8 ± 0.9% to 6.1 ± 0.7%, </span></span></span><span style="font-family:"Calibri",sans-serif">p<0.01)</span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">. Additionally, after the CR program, the number of patients with LVEF below 50% decreased from 206 to 91. </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Clinically, most patients were in NYHA class I after rehabilitation, with an improvement in NT-proBNP levels and a trend toward enhanced functional capacity as assessed by the 6-minute walk test.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">The mean follow-up duration was 2.97 ± 1.69 years. During this period, 44 patients (8%) were hospitalized and 21 patients (4%) died, 13 of whom </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">due<span style="color:black"> to cardiovascular causes. The mean time to the first composite event was 1.94 ± 1.23 years.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">These results highlight the importance of CR in improving both functional capacity and </span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">clinical outcomes in <span style="color:black">patients with cardiovascular disease. </span></span></span></span></span></p> <p> </p>
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