EFFECTS OF CARDIAC REHABILITATION ON FUNCTIONAL CAPACITY AND CARDIOVASCULAR RISK FACTORS IN BRAZILIAN PATIENTS ASSISTED BY PUBLIC HEALTH CARE: PROTOCOL OF A RANDOMIZED CONTROLLED TRIAL

BACKGROUND: The leading non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of deaths occurring in low and middle-income countries (LMICs). In the MIC of Brazil, CVD is also the leading cause of mortality. To lessen the impact of CVDs on individuals and societies, a comprehensive approach such as cardiac rehabilitation (CR) is needed. Although there are many trials conducted in high-income countries, which show benefits and feasibility of CR, there have only been trials in the LMICs of China and Thailand. Therefore it is unclear whether similar results can be achieved in Brazil. The objective of this trial is to investigate whether participation in a comprehensive CR program in the MIC Brazil results in better functional capacity, cardiovascular risk factor control, health behaviour and disease-related knowledge when compared to exercise-based CR or usual care. METHODS: The design is a single-blinded pragmatic RCT with 3 parallel arms: comprehensive CR (includes education) vs. exercise-based CR (no education) vs. usual care (no CR). Random allocation is concealed. Patients in the CR group will be referred for 6 months of exercise classes (3 times/week at the beginning to 1 time/week), based on an individualized prescription from an exercise test. The comprehensive CR group will also receive 24 weekly educational sessions regarding the core components of CR and a workbook (developed empirically in Canada, and translated and crossculturally adapted for Brazil). The target sample size is 186. The primary outcome is functional capacity assessed by the Shuttle Walk Test at pre-test, and again after 3 and 6-months. The secondary outcomes of risk factor control will be assessed by blood pressure (hypertension), body mass index plus waist circumference (obesity), smoking, and lipids (dyslipidemia). The tertiary outcomes of heart-healthy behaviors, namely exercise, cardiac medication adherence, diet, depressive symptoms, and CVD knowledge will be evaluated by psychometrically-validated questionnaires pre and post-program and pedometers. MANCOVAs will be performed, adjusting for pre-test values. RESULTS: To date, 18 participants have been randomized. Preliminary results will be presented. We anticipate that participants exposed to either CR arm will have better functional capacity, and those exposed to comprehensive CR will have better risk factor control and behaviour than participants randomized to usual care. CONCLUSION: This trial may provide the evidence basis for the benefits of CR in Brazil. This can then be used to advocate for greater availability and reimbursement of CR services. 032 COMPLICATIONS OF 7,397 PERSANTINE MIBI SCANS PERFORMED IN A COMMUNITY CARDIOLOGY CLINIC