PURPOSE The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated. METHODS Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AE and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions. RESULTS During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. Adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared with the low- or medium-risk groups, the high-risk group was more likely to have AE (HR 3.0 [95% CI, 1.7-5.9], P = .002) and CE (HR 3.7 [95% CI, 1.5-10.8], P = .002) with fair model discrimination (area under the curve: 0.637, P < .001). CONCLUSION The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE.

中文翻译：

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美国心血管和肺康复协会不进行运动测试的运动风险分层分类工具的评估。

目的美国心血管和肺康复协会 (AACVPR) 建议开始心脏康复 (CR) 的患者进行分层，以确定运动相关不良事件 (AE) 的风险，但该工具最近尚未经过评估。方法 在 2016 年入组 CR 的患者中，我们使用 AACVPR 风险分层工具来评估 AE 和临床事件 (CE) 的风险。我们将 AE 定义为在 CR 期间妨碍或中断运动的体征或症状，将 CE 定义为在 CR 运动课程之外需要紧急评估的事件。结果 在研究期间，纳入了 657 名心血管诊断患者，并分为高风险 (58%)、中风险 (31%) 或低风险 (11%)。在 CR 过程中（76 天，17 个疗程），出现 63 例 AE 和 33 例 CE。不良事件大多较轻微（没有心脏骤停或死亡），并由 CR 工作人员处理。与低或中风险组相比，高风险组更有可能发生 AE（HR 3.0 [95% CI，1.7-5.9]，P = .002）和 CE（HR 3.7 [95% CI，1.7-5.9]）和 CE（HR 3.7 [95% CI ，1.5-10.8]，P = .002），具有公平的模型歧视（曲线下面积：0.637，P < .001）。结论 AACVPR 风险分层工具可以公平区分 AE 和 CE，但事件发生率较低且大多较轻微。因此，AACVPR 模型可能需要重新评估，以更好地识别真正有重大 AE 风险的患者。