Background and Aims:
The incidence of fatal and non-fatal cardiac events occurring during or shortly after cardiac rehabilitation exercise sessions is low. The infrequency of these events challenges the notion of onsite physician supervision during exercise. The interventional cardiac rehabilitation program (CRP) offered at the Cardiac Wellness Institute of Calgary (CWIC) utilizes risk stratification, based on the results of an initial treadmill test, to determine candidates for EKG telemetry monitoring. Patients attend this community-based, onsite medically supervised exercise program for one hour twice per week for a period of up to twelve weeks. Exercise sessions are directly supervised by Exercise Specialists with Registered Nurses available in the exercise area to triage patient symptoms and determine the need for further assessment by the onsite physician. The purpose of this investigation was to: 1. Quantify the nature and frequency of adverse events during supervised exercise at the CWIC; and 2. Determine whether a relationship exists between the frequency of adverse events and patient risk stratification (RS) and/or telemetry monitoring.
Methods:
Data were prospectively collected over 36 months from March 2003 to February 2006. When patients experienced adverse events during exercise warranting physician assessment and/or treatment, patient risk stratification, telemetry monitoring status, nature of event and treatment were recorded.
Results:
No fatal events were observed during the timeline studied. A total of 494 adverse events requiring physician assessment occurred in 34,995 patient exercise hours. The nature and frequency of events distributed by RS are presented in Figure 1. Frequency of telemetry monitoring by adverse event was as follows: dysrhythmia (Dys): 43.0%, other events (Oth): 11.4%, blood pressure (BP): 9.5%, classic symptoms (CS) (ie: shortness of breath, pallor, diaphoresis, nausea, fatigue): 6.3%, chest pain (CP): 3.3% and blood sugar (BS): 0.0 %. Of the 494 adverse events observed, 14 patients were sent to hospital for further evaluation, 9 classified as urgent transport via ambulance (1 Code 99), 5 classified as non-urgent transport by car with a family member.
Conclusions:
Adverse events occurred at a rate of approximately 3 per week during the study period. Of patients presenting with adverse events, 14.6% were telemetry monitored and events related to CP occurred most frequently. The overall incidence of adverse events by RS mirrored the distribution of patient RS within the program, i.e., most patients were stratified as moderate risk and the majority of adverse events occurred within this group. Although the observed number of adverse events is relatively low in this study, onsite physician evaluation resulted in 480 fewer additional physician interactions and/or ambulance transports and emergency room (ER) visits. Furthermore, patient concerns were addressed in a timely fashion, resulting in less interruption of their course in the CRP.
Section Description
For more information, contact Marilyn Thomas (204) 488-5854