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Identifying Patients at Low Risk for Activity-Related Events: THE RARE SCORE

Lacombe, Shawn P. MSc; LaHaye, Stephen A. MD, FRCPC; Hopkins-Rosseel, Diana PT, MSc; Ball, David MSc; Lau, Winnie PT, MSc

Journal of Cardiopulmonary Rehabilitation & Prevention:
doi: 10.1097/HCR.0000000000000045
Cardiac Rehabilitation
Abstract

PURPOSE: To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately identifies patients who are at low risk of experiencing an adverse event while exercise training at cardiac rehabilitation.

METHODS: Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score < 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented.

RESULTS: Individuals (n = 656) were eligible for analysis (high risk: n = 260; low risk: n = 396). Eleven events (1 major, 10 minor) were recorded during the study, and the overall event rate was low (1 event per 1321 patient hours of exercise training). Individuals triaged as high-risk had significantly more events than the low-risk cohort (high risk: n = 8 vs low risk: n = 3; P = .024) and were 4 times more likely to experience an adverse event (OR: 4.2; 95% CI: 1.0–20.0). More than 99% of low-risk patients were event free (negative predictive value: 99.2%; 95% CI: 98.3–99.8), while participating in exercise at cardiac rehabilitation.

CONCLUSION: The RARE Score accurately identifies patients who are at low risk of experiencing adverse events during exercise training at cardiac rehabilitation. The identification of low-risk patients allows for the possibility of reduced on-site supervision and monitoring, or the provision of alternative models of cardiac rehabilitation, including community- or home-based cardiac rehabilitation programs.

In Brief

Cardiac patients (n = 656) were stratified using the Risk of Activity Related Events (RARE) Score and monitored for adverse events during cardiac rehabilitation. The RARE Score accurately identified patients at low risk for an adverse event, with more than 99% of low-risk patients being event free while participating in cardiac rehabilitation.

Author Information

Queen's University, Kingston, Ontario, Canada (Messrs Lacombe and Ball); Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada (Dr LaHaye and Ms Hopkins-Rosseel); and Royal Alexandra Hospital, Queen's University, Edmonton, Alberta, Canada (Ms Lau).

Correspondence: Stephen A LaHaye, MD, FRCPC, Hotel Dieu Hospital, Queen's University, 166 Brock St, Kingston, ON K7L 5G2, Canada (stephenlahaye@hotmail.com).

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins