Prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation

BackgroundThe prognostic value of cycle exercise testing prior to and after outpatient cardiac rehabilitation (OCR) is not well established.Methods2146 consecutive patients undergoing symptom-limited cycle exercise testing at OCR entry, of whom 1853 (86%) also had a test at end of OCR, were followed for a median of 33 months.ResultsAll-cause and cardiovascular annual mortality rates were 1.2% and 0.8%, respectively. At OCR entry, older age, diabetes, lower left ventricular ejection fraction (LVEF), calcium channel blocker use, and lower workload [hazard ratio (HR) 2.38 if ≤ 105 W; p < 0.001] were independent predictors of death. Diabetes, diuretic use, and lower workload [HR 3.53 if ≤ 105 W; p = 0.001] were independently associated with cardiovascular death. At end of OCR, older age, lower LVEF, lower workload (HR 2.34 if < 140 W; p = 0.009), and lower increase in peak heart rate from entry to end of OCR (HR 2.46 if < 4 bpm; p = 0.002) were independently associated with all-cause mortality. Older age, lower LVEF, lower increase in systolic blood pressure (HR 2.97 if < 54 mm Hg; p = 0.02), and lower increase in peak heart from entry to end of OCR (HR 2.72 if < 4 bpm; p = 0.013) were independently associated with cardiovascular mortality. Failure to undergo a test at end of OCR was an additional independent predictor of all-cause (HR 2.51; p < 0.001) and cardiovascular mortality (HR 2.56; p = 0.003).ConclusionSymptom-limited cycle exercise testing prior to and after OCR provides important prognostic information.