Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation

Abstract

ObjectiveTo survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR.MethodAll cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9±10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).ResultsThe study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours).ConclusionEarly hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.

Safety and efficacy of in-hospital cardiac rehabilitation following antiarrhythmic therapy for patients with electrical storm

“…In contrast, existing evidence suggests that in-hospital rehabilitation is less safe. According to a report from a Korean institution in which >90% of enrolled patients had coronary artery disease, the event rate in an inpatient setting was one per 820 patient-hours under supervised exercise [18]. In the current study, 13 VT/VF recurrent episodes occurred, but only one occurred during exercise training (corresponding to one event per 408 patient-hours).…”

The Surgically Induced Stress Response

“…Even patients undergoing cardiac procedures have been recommended some form of controlled cardiac rehabilitation program. Recently, a 10‐year study investigated the incidence of cardiovascular events in 975 patients post–cardiovascular surgery while exercising during cardiac rehabilitation 35 . These patients underwent various procedures including percutaneous transluminal coronary angioplasty (PTCA; 75%), post–cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).…”

Advances in rehabilitation medicine

“…(90) However, patients should be stratified, such as according to the levels of cognitive deficits in neurologic disorders or cardiopulmonary fitness post myocardial infarction, with exercise intensity individualised according to illness severity in the relevant populations. (86,91,94) Generally, studies indicate that VER results in faster recovery in the ability to perform activities of daily living and the return to walking in neurorehabilitation patients, as well as quicker rates of recovery from subsequent exacerbations in COPD patients. (87,92) Almost all studies report a shorter length of hospital stay.…”