Os protocolos de estratificação de risco cardíaco são eficazes em prever intercorrências, durante a realização de um programa de reabilitação cardiovascular?
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Data
2020-02-06
Autores
Ribeiro, Felipe [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Os programas de reabilitação cardiovascular (PRCV) são importantes para cardiopatas em geral e indivíduos com fatores de risco cardiovasculares, porém, podem ser associados com o risco de surgimento de sinais e sintomas durante o seu desenvolvimento, e, investigar possíveis fatores que possam predizer a possibilidade destes durante a sua realização, como por exemplo a estratificação de risco cardíaco, é de extrema importância no cenário clínico. Objetivos: Avaliar a precisão dos protocolos de estratificação de risco em prever sinais e sintomas durante a realização de um PRCV. Materiais e Métodos: Foram realizadas estratificações de risco cardíaco em 7 protocolos diferentes de 80 pacientes atendidos em um PRCV e acompanhados por um período de 24 sessões para avaliação de sinais e sintomas. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk e a relação entre o número de intercorrências dos pacientes e as estratificações de risco foi analisada pela correlação de Pearson/Spearman. Foram avaliadas a sensibilidade, a especificidade e acurácia para a ocorrência de eventos. A área sob a curva foi considerada significativa quando valores ≥ 0,650 foram obtidos. Todos os resultados foram discutidos no nível de 5% de significância. Resultados: Não foram encontradas correlações significantes entre a ocorrência de sinais e sintomas e os protocolos de estratificação de risco cardíaco (p > 0,05). O protocolo da American Heart Association (AHA) apresentou melhor acurácia (0,61 [0,49 – 0,73]) e especificidade (0,67 [0,35 – 0,90]). O protocolo da Sociedade Francesa de Cardiologia (SFC), apresentou os melhores resultados para sensibilidade (0,59 [0,48 – 0,73]). Conclusão: Os protocolos avaliados não apresentarem correlações significantes entre as classes de risco e a ocorrência de sinais e sintomas durante os PRCV, entretanto seu uso nesses programas ainda é extremante importante para o manejo e segurança dos pacientes.
Cardiovascular rehabilitation programs (CRP) are important for cardiac patients in general and individuals with cardiovascular risk factors, however, they can be associated with the risk of the appearance of signs and symptoms during their development, and, investigate possible factors that may predict the the possibility of these during its performance, such as stratification of cardiac risk, is extremely important in the clinical setting. Objectives: Evaluate the accuracy of risk stratification protocols in predicting signs and symptoms during the performance of a CRP. Materials and Methods: Cardiac risk stratifications were performed in 7 different protocols of 80 patients treated at a CRV and followed for a period of 24 sessions to assess signs and symptoms. The normality of the data was verified by the Shapiro-Wilk test and the relationship between the number of complications of the patients and the risk stratifications was analyzed by the Pearson/Spearman correlation. Sensitivity, specificity and accuracy for the occurrence of events were evaluated. The area under the curve was considered significant when values ≥ 0.650 were obtained. All results were discussed at the 5% significance level. Results: No significant correlations were found between the occurrence of signs and symptoms and the cardiac risk stratification protocols (p> 0.05). The American Heart Association (AHA) protocol showed better accuracy (0.61 [0.49 - 0.73]) and specificity (0.67 [0.35 - 0.90]). The protocol of the French Society of Cardiology (SFC), presented the best results for sensitivity (0.59 [0.48 - 0.73]). Conclusion: The evaluated protocols do not present significant correlations between risk classes and the occurrence of signs and symptoms during PRCV, however their use in these programs is still extremely important for the management and safety of patients.
Cardiovascular rehabilitation programs (CRP) are important for cardiac patients in general and individuals with cardiovascular risk factors, however, they can be associated with the risk of the appearance of signs and symptoms during their development, and, investigate possible factors that may predict the the possibility of these during its performance, such as stratification of cardiac risk, is extremely important in the clinical setting. Objectives: Evaluate the accuracy of risk stratification protocols in predicting signs and symptoms during the performance of a CRP. Materials and Methods: Cardiac risk stratifications were performed in 7 different protocols of 80 patients treated at a CRV and followed for a period of 24 sessions to assess signs and symptoms. The normality of the data was verified by the Shapiro-Wilk test and the relationship between the number of complications of the patients and the risk stratifications was analyzed by the Pearson/Spearman correlation. Sensitivity, specificity and accuracy for the occurrence of events were evaluated. The area under the curve was considered significant when values ≥ 0.650 were obtained. All results were discussed at the 5% significance level. Results: No significant correlations were found between the occurrence of signs and symptoms and the cardiac risk stratification protocols (p> 0.05). The American Heart Association (AHA) protocol showed better accuracy (0.61 [0.49 - 0.73]) and specificity (0.67 [0.35 - 0.90]). The protocol of the French Society of Cardiology (SFC), presented the best results for sensitivity (0.59 [0.48 - 0.73]). Conclusion: The evaluated protocols do not present significant correlations between risk classes and the occurrence of signs and symptoms during PRCV, however their use in these programs is still extremely important for the management and safety of patients.
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Palavras-chave
Serviço de reabilitação, Sinais e sintomas, Risco cardíaco, Protocolos clínicos, Doenças cardiovasculares, Rehabilitation service, Signals and symptons, Heart risk, Clinical protocols, Cardiovascular diseases