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Palma A1, Pereira C1, Probert H2, Shannon H1
1University College London, UCL Great Ormond Street Institute of Child Health, London, United Kingdom, 2Royal Brompton and Harefield Hospital, Cardiac Rehabilitation, London, United Kingdom
Background: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Functional capacity is an important predictor of cardiac morbidity and mortality in these patients. Cardiac rehabilitation is an evidence-based exercise and education programme, designed to optimise physical, mental and social well-being and cardiovascular health. The British Association for Cardiac Prevention and Rehabilitation recommends the use of field tests as an assessment of functional capacity in cardiac rehabilitation. The incremental shuttle walk test has been shown to have strong reliability, test-retest reliability, validity and responsiveness in cardiac populations (Hanson et al., 2016; Pepera et al., 2010). The safety of the incremental shuttle walk test using electrocardiogram (ECG) monitoring has not been extensively studied. Furthermore, the possible impact that ECG monitoring during the incremental shuttle walk test will have on cardiac risk stratification (a way of assessing the level of supervision required, and type of exercise programme prescribed) has not been explored.
Purpose: To investigate the safety of the incremental shuttle walk test by exploring the incidence of ECG changes during the test, and to report on the possible impact of these ECG findings on cardiac risk stratification.
Methods: A retrospective case note review was adopted, using clinical data that had been collected in 2017 at a world leading cardiac hospital in London, United Kingdom. Baseline clinical characteristics of all patients were gathered, along with ECG findings analysed by ECG monitoring. Additionally, the impact of ECG findings on cardiac risk stratification was measured.
Results: Data were gathered for 295 patients. Only minor ECG changes were identified during initial incremental shuttle walk tests in 189 patients (64.1%), confirming that the test is safe from a cardiac perspective. The presence of a silent myocardial ischaemia (indicated by ST-segment depression) was identified in 60 patients (20%), and had an impact on their final cardiac risk stratification in 27 cases. Eighteen of these patients had a 'moderate' risk classification, but would have been classified as 'low risk' without the ECG findings, while nine with 'high' risk would otherwise have been classified as 'moderate.' There was a statistically significant association between ST-segment depression with cardiac risk stratification (p 0.001).
Conclusion(s): The use of ECG monitoring during the incremental shuttle walk test as an assessment tool in cardiac rehabilitation confirmed the safety of the test. The impact of ECG findings on cardiac risk stratification is a significant finding, which warrants further investigation.
Implications: ECG monitoring should be considered in cardiac rehabilitation assessments. The additional information that results from ECG monitoring is vital to identifying the presence of frequent ECG changes, such as ectopics beats. Caution should be taken if patients show frequent ventricular or atrial ectopics during the test and further medical investigations are recommended. Additionally, the identification of silent myocardial ischaemia represented by ST-segment depression, can impact on cardiac risk stratification in some patients, suggesting that this information is essential to achieve an accurate risk stratification and individualised prescription of exercise. This directly affects clinical practice and decision-making, providing essential information for both clinicians and patients.
Keywords: Cardiac rehabilitation, Electrocardiogram monitoring, Cardiac risk stratification
Funding acknowledgements: This project was part of my post-graduate studies (MSc degree). An schoolarship for the MSc was only necessary.
Purpose: To investigate the safety of the incremental shuttle walk test by exploring the incidence of ECG changes during the test, and to report on the possible impact of these ECG findings on cardiac risk stratification.
Methods: A retrospective case note review was adopted, using clinical data that had been collected in 2017 at a world leading cardiac hospital in London, United Kingdom. Baseline clinical characteristics of all patients were gathered, along with ECG findings analysed by ECG monitoring. Additionally, the impact of ECG findings on cardiac risk stratification was measured.
Results: Data were gathered for 295 patients. Only minor ECG changes were identified during initial incremental shuttle walk tests in 189 patients (64.1%), confirming that the test is safe from a cardiac perspective. The presence of a silent myocardial ischaemia (indicated by ST-segment depression) was identified in 60 patients (20%), and had an impact on their final cardiac risk stratification in 27 cases. Eighteen of these patients had a 'moderate' risk classification, but would have been classified as 'low risk' without the ECG findings, while nine with 'high' risk would otherwise have been classified as 'moderate.' There was a statistically significant association between ST-segment depression with cardiac risk stratification (p 0.001).
Conclusion(s): The use of ECG monitoring during the incremental shuttle walk test as an assessment tool in cardiac rehabilitation confirmed the safety of the test. The impact of ECG findings on cardiac risk stratification is a significant finding, which warrants further investigation.
Implications: ECG monitoring should be considered in cardiac rehabilitation assessments. The additional information that results from ECG monitoring is vital to identifying the presence of frequent ECG changes, such as ectopics beats. Caution should be taken if patients show frequent ventricular or atrial ectopics during the test and further medical investigations are recommended. Additionally, the identification of silent myocardial ischaemia represented by ST-segment depression, can impact on cardiac risk stratification in some patients, suggesting that this information is essential to achieve an accurate risk stratification and individualised prescription of exercise. This directly affects clinical practice and decision-making, providing essential information for both clinicians and patients.
Keywords: Cardiac rehabilitation, Electrocardiogram monitoring, Cardiac risk stratification
Funding acknowledgements: This project was part of my post-graduate studies (MSc degree). An schoolarship for the MSc was only necessary.
Topic: Cardiorespiratory
Ethics approval required: No
Institution: University College London, RBHT NHS Foundation Trust
Ethics committee: UCL research and development office, RBHT NHS Foundation Trust
Reason not required: Ethical approval was not required, since the project was deemed to be a service evaluation by both the UCL research and development office and clinical audit team, Royal Brompton and Harefield NHS Foundation Trust. It was registered as a service evaluation, study number 002385.
All authors, affiliations and abstracts have been published as submitted.
