Risk predictors and frequency of cardiovascular symptoms occurring during cardiac rehabilitation programs in phase III-WHO.

Introduction: Rehabilitation in ambulatory heart groups has become a well established part of comprehensive cardiac treatment in Germany. Identifying patients at risk for cardiovascular symptoms is important for the efficiency and safety of the program.

Methods: Questionnaires were mailed to ambulatory heart groups in the state of Hessen, Germany, and returned by 1935/13 174 (15%) patients, age 65.9 +/- 7.6 years, 1504/1935 (77.7%) males, comprising approximately 674 000 patient exercise hours.

Results: 828 symptoms were reported by 538 patients, comprising dyspnea in 330/538 (61.3%), angina pectoris in 80/538 (14.9%), palpitation in 145/538 (27%), tachycardia in 59/538 (11%), dizziness in 152/538 (28.3%), fainting in 6/538 (1.1%), and others in 47/538 (8.7%). Cardiovascular symptoms occurred more frequently in patients presenting with overexertion (43/68 (63.2%), p < 0.0001, RR 4.77 [95% CI 3.01-7.56]), chronic heart failure (115/291 (39.5%) vs 419/1624 (25.8%), p < 0.0001, RR 1.88 [95% CI 1.45-2.43]), lower exercise capacity (1.49 +/- 0.4 vs 1.59 +/- 0.5 W/kg body weight, p = 0.0002, mean difference -0.096 [95% CI (-0.146) -(-0.046)]), hypertension (269/ 854 (31.5%) vs 266/1068 (24.9%), p = 0.001, RR 1.39 [95% CI 1.14-1.69]), and hyperlipidemia (280/ 907 (30.9%) vs 255/1015 (25.1%), p = 0.005, RR 1.33 [95% CI 1.09-1.63]). Cardiovascular symptoms were more frequent in women (141/431(32.7%) vs 397/1503 (26.4%), p = 0.01, RR 1.35 [95% CI 1.08-1.71]). Overexertion (p < 0.0001), heart failure (p = 0.003), and hypertension (p = 0.05) are significant independent predictors of cardiovascular symptoms, while female gender (p = 0.06), and hyperlipidemia (p = 0.07) are not as significant. Previous myocardial infarction and diabetes had no statistical significant impact on cardiovascular symptoms.

Conclusion: Patients likely to experience cardiovascular symptoms in ambulatory rehabilitation can be identified by their medical history and perceived exertion.