Risk Stratification

• • One very important use of MET max is for the purposes of risk stratification
  • Risk stratification is the assessment of current cardiac status to predict the chances of a cardiac event during exercise
• Besides MET max, what criteria are used to determine risk:

  • Indicators of severity of event e.g. anterior MI, previous MIs, large infarcts (enzymes ++), complicated recovery (cardiogenic shock)
  • Indicators of LV function e.g. Moderate (Ejection Fraction = 35-49%), Poor (Ejection Fraction <35%) or diagnosed with heart failure
  • Indicators of ongoing ischaemia e.g. positive ECG, ongoing angina symptoms
  • Implantable cardioverter defibrillator
  • Awaiting further investigations
  • Other considerations e.g. arrhythmias (especially ventricular), cardiac arrest secondary to event
• How do you categorise risk:

  • In people with coronary disease the most typically used method to risk stratify for cardiac events during exercise is by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
  • the individual is assessed and subsequently categorised as either LOW, MODERATE or HIGH risk for a cardiac event during exercise
  • NEED TO LEARN THIS TABLE

  
• Purpose of risk stratification

  • Activity can be optimised whilst minimising risks e.g. a low risk patient would be encouraged to exercise at the upper end of the training ranges and higher risk patients at the lower end (or even under optimal levels in some cases where ischaemia is at low intensities for example).
  • Monitoring can be individualised i.e. you would expect much closer monitoring in higher risk patients