Extreme cardiovascular risk in cardiological rehabilitation: prevalence and impact on patient’s functional improvement

Abstract

Background and Aims: Among patients at very high cardiovascular risk, some are more likely to experience recurrent cardiovascular events. In May 2022, an article was published in the European Heart Journal proposing different definitions of patients at extreme cardiovascular risk. However, the process of defining such patient is still ongoing and more data on its prevalence are needed. Our aims consisted in assessing the prevalence of patients at extreme cardiovascular risk in cardiological rehabilitation and in evaluating the clinical features of such patients. Furthermore, we wanted to establish how the extreme cardiovascular risk condition correlates with the functional improvement obtained during cardiac rehabilitation. Methods: The study included 938 patients suffering from atherosclerosis who attended the cardiological rehabilitation of Niguarda Hospital in Milan. Patients classified as at extreme cardiovascular risk were compared with the remaining patients and a multivariate linear regression was performed with absolute functional improvement as the dependent variable. Results: Among 938 patients, 26.9% belong to the category of extreme cardiovascular risk. Patients at extreme cardiovascular risk showed a higher average age (67.8 ± 10.4 vs 64.1 ± 11.1 years; p ≤ 0.001), a higher prevalence of significant comorbidities (peripheral arterial disease, cerebrovascular disease, dyslipidemia, diabetes, chronic kidney disease, hypertension) and a lower functional improvement during cardiac rehabilitation (102.9 ± 68.6 vs 138.1 ± 86.5 m; p ≤ 0.001). At multivariate analysis extreme cardiovascular risk remains a significant determinant of the absolute functional improvement at Six-Minute Walking Test obtained during cardiac rehabilitation with b = -0.137 and p = 0.035, together with female sex (b = -0.136; p = 0.035). Conclusions: Extreme cardiovascular risk is a widespread condition among patients with chronic coronary syndrome and adversely affects the patient’s functional improvement during cardiac rehabilitation. The identification of patients at extreme cardiovascular risk is a goal to be pursued in order to intensify secondary prevention strategies.