P496 EXTREME CARDIOVASCULAR RISK IN CARDIOLOGICAL REHABILITATION: PREVALENCE AND IMPACT ON PATIENT’S FUNCTIONAL IMPROVEMENT

Abstract

Abstract Background 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 the patient at extreme cardiovascular risk is still ongoing and more data also on its prevalence are needed. Aims: To assess the prevalence of patients at extreme cardiovascular risk in cardiological rehabilitation, to evaluate the clinical features of these patients. Furthermore, we want 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 diagnosed with non–ischemic heart failure or congenital heart disease have been excluded. 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, chronic kidney disease, dyslipidemia, diabetes, 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). Conclusion 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.