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Cardiac rehab score predicts event risk at 1 year

Cardiac rehab score predicts event risk at 1 year

August 19, 2022

2 min read

The authors report no relevant financial disclosures.

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Exercise performance during cardiac rehabilitation, scored with a novel index, can reliably predict CV event risk at 1 year, according to data from a single-center study.

Participating in a cardiac rehabilitation program is essential to improving patients’ survival and quality of life following myocardial infarction or heart surgery and for patients with HF,” Ofir Koren, MD, FESC, an interventional cardiology fellow with the Cedars-Sinai Medical Center Smidt Heart Institute and a senior interventional cardiologist with Emek Medical Center in Afula, Israel, told Healio. “Our study supports previous evidence and emphasizes the importance of understanding the level of endurance required to promote improved outcomes by designing a simple-to-use formula that can guide physicians and physiotherapists toward a target-directed program.”

Graphical depiction of source quote presented in the article

Data were derived from Naami R, et al. Clin Cardiol. 2022;doi:10.1002/clc.23890.

Koren and colleagues analyzed data from 486 adults who participated in at least 80% of sessions in a cardiac rehabilitation program between January 2018 and August 2021 at Emek Medical Center in Israel. The rehab program is a twice weekly, 3-month government-funded program; each session includes exercises on a treadmill, elliptical, bicycle and handcycle. Researchers assessed patient performance using a novel index, the “CR score,” which integrated duration, speed of work and workload conducted on each training device. Researchers then determined the optimal thresholds for a cumulative CR score and assessed the mortality rate among patients who developed a major adverse CV event and those who did not (controls).

The findings were published in Clinical Cardiology.

Major adverse CV events occurred in 5.5% of patients at 1 year; events were more common among those with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%; P < .001). Age, sex, comorbidities, HF and medical treatment did not affect the outcome.

The median cumulative CR score of the study group was lower compared with controls (median, 595 vs. 3,500; P < .0001). A cumulative CR score of greater than 1,132 correlated with the outcome with 98.5% sensitivity and 99.6% specificity (95% CI, 0.9850.997; P < .0001). Patients older than age 55 years with a cumulative CR score of greater than 1,132 were deemed at highest risk for a major adverse CV event at 1 year, with an OR of 7.4 (95% CI, 2.84-18.42); Kaplan-Meier survival curve indicated that major adverse CV events at 1 year occurred much earlier among patients with a low CR score (log-rank P = .03).

The researchers noted that the CR score is a novel score that has not been validated on a large scale.

“These data may assist physicians and physiotherapists in tailoring a specific CR program with clear physical targets,” Koren, also a clinic lecturer at Technion University in Israel, told Healio. “We need a prospective study involving two groups randomly assigned to two therapeutic options — current CR practice and a CR program directed using our model.”

For more information:

Ofir Koren, MD, FESC, can be reached at; Twitter: @dr_ofir.

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Alexander Zverev ‘should be banned from big events, undergo rehab process’, says Mats Wilander

Alexander Zverev 'should be banned from big events, undergo rehab process', says Mats Wilander

Eurosport expert Mats Wilander has given his views on Alexander Zverev being allowed to continue playing tennis so soon after striking an umpire’s chair in a shockingly violent fashion in Mexico.

The world No. 3 was handed the maximum fine by the ATP following his vicious reaction at the Mexican Open as he struck Alessandro Germani’s chair several times with his racquet after his doubles defeat alongside Marcelo Melo against Lloyd Glasspool and Harri Heliovaara.
Zverev was thrown out of the tournament and fined $40,000 (£30,000), plus a full forfeit of his prize money and ATP ranking points. He had yelled while narrowly avoiding hitting the umpire: “You f****** destroyed the whole f****** match. The whole f****** match”.

Davis Cup

Zverev makes Davis Cup U-turn to play for Germany after Acapulco disqualification


The 24-year-old apologised for his outburst and made a sudden U-turn to represent Germany against Brazil in the Davis Cup in Rio de Janeiro on March 4 and 5 – something he has not done since February 2019.

Wilander believes the punishment was nowhere near strong enough and Zverev should not be permitted to be back in action so soon after such a shocking incident.

“If a player breaks his racquet on the umpire’s chair and he is literally a few centimetres away from hitting the umpire’s leg, he should not be allowed to get on a tennis court until he has gone through some kind of rehab, some kind of time,” Wilander told Eurosport.

“We need to punish him accordingly, and allowing him to come out and play professional tennis the week after or two weeks after, that is too soon.

Alexander Zverev – ATP Acapulco

Image credit: Eurosport

“To me, money does not do it, and I think you either give someone with that behaviour a three-month suspension or a six-month suspension. You do not allow him to play the most important tournaments on his calendar. Now, the most important tournaments are most probably the Grand Slams, the ATP 1000, the Davis Cup.

“I mean, I do not know where you draw the line, but certainly going out and competing in any shape or form straight away, it does not seem like that is very fair to other players.

“Maybe it is time to have some kind of a professional body of tennis that makes all these decisions, and it is the combination of the ATP, the ITF, the WTA, the Olympic committee. We get together, and these kinds of behaviours, no, you’re not allowed to play on any circuit until you have gone through some kind of a rehabilitation process.

“So no, it is not great for tennis. For him personally, it is most probably a good move that he can suddenly start playing, not just for himself, but to play for his country and his team-mates. But no, I think that is … it does not send a great message for professional tennis.

“I applaud him for being an emotional wreck at the end of the loss in a doubles match – that just shows that he cares, but you have to show that you care in different ways.

“I think I go back to what happened against Denis Shapovalov at the Australian Open. After 45 minutes, he was destroying a tennis racquet on the court.

‘The disqualification was not too harsh’ – Djokovic on Zverev’s outburst in Mexico

“I do not like destroying tennis racquets, even though it has become more and more acceptable in the professional world of tennis.

“I absolutely hate that behaviour because there are more tennis players in the world that cannot afford a second racquet. So do not show the kids that that is how we treat the material that we use.”


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