Peak oxygen consumption achieved at the end of cardiac rehabilitation predicts long-term survival in patients with coronary heart disease

Salvatore Carbone; Youngdeok Kim; Sergey Kachur; Hayley Billingsley; Jonathan Kenyon; Alban De Schutter; Richard V Milani; Carl J Lavie

doi:10.1093/ehjqcco/qcab032

Peak oxygen consumption achieved at the end of cardiac rehabilitation predicts long-term survival in patients with coronary heart disease

Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):361-367. doi: 10.1093/ehjqcco/qcab032.

Authors

Salvatore Carbone^{1

2}, Youngdeok Kim¹, Sergey Kachur³, Hayley Billingsley^{1

2}, Jonathan Kenyon¹, Alban De Schutter³, Richard V Milani³, Carl J Lavie³

Affiliations

¹ Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 1020 W Grace Street, Richmond, VA, 23220, USA.
² VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, 1020 E Broad Street, Richmond, VA 23298, USA.
³ John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121-2483, USA.

Abstract

Aims: Cardiac rehabilitation (CR) improves survival in patients with coronary heart disease (CHD), which is largely mediated by the improvements in cardiorespiratory fitness (CRF) defined as peak oxygen consumption (VO2). Therefore, measuring CRF is essential to predict long-term outcomes in this population. It is unclear, however, whether peak VO2 achieved at the end of CR (END-peak VO2) predicts survival or whether the changes of CRF achieved during CR provide a greater prognostic value. To determine whether END-peak VO2 independently predicts long-term survival in patients with CHD undergoing CR. We also aimed at identifying cut-offs for END-peak VO2 that could be used in clinical practice.

Methods and results: Retrospective analysis of 853 patients with CHD referred to CR who completed a maximal cardiopulmonary exercise test. Survival analysis was performed to examine the risk of all-cause mortality (average follow-up years: 6.65) based on peak VO2. The Contal and O'Quigley's method was used to determine the optimal cut-off of END-peak VO2 based on the log-rank statistic. END-peak VO2 was inversely associated with mortality risk [hazard ratio (HR) = 0.84; 95% confidence interval (CI) = 0.78-0.90], independent of changes in peak VO2 adjusted for the baseline peak VO2. The estimated cut-off of END-peak VO2 at ≥17.6 mL/kg/min best predicted the survival with high predictive accuracy and patients with END-peak VO2 under the cut-off had a greater risk of mortality (HR = 2.93; 95% CI = 1.81-4.74).

Conclusions: In patient with CHD undergoing CR, END-peak VO2 is an independent predictor for long-term survival. Studies utilizing higher intensity CR programmes, with and without pharmacologic strategies, to increase peak VO2 to a greater degree in those achieving a suboptimal END-peak VO2, are urgently needed.

Keywords: Cardiorespiratory fitness; Coronary heart disease; Exercise training; Cardiac rehab.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cardiac Rehabilitation* / methods
Coronary Disease*
Exercise Test
Humans
Oxygen Consumption
Retrospective Studies

Grants and funding

UL1 TR002649/TR/NCATS NIH HHS/United States