Preditores da capacidade funcional em doentes coronários

Introduction: Functional capacity is a major determinant of morbidity, mortality and quality of life in most cardiovascular diseases. Understanding and identifying functional capacity predictors will allow fine-tuning of strategies and components of cardiac rehabilitation programs (CRP) in order to minimize disability and enhance patients social and vocational status. We aim to identify predictors of functional capacity at the end of phase II CRP in coronary heart disease patients, irrespective of initial functional status. The purpose of this study was to determine the functional capacity predictors in acute coronary syndrome (ACS) patients undergoing a phase II cardiac rehabilitation program (CRP). Methods: Prospective study enrolling consecutive patients admitted to an outpatient CRP after an acute coronary event between September 2008 and November 2011. Only patients who completed a formal phase II CRP were considered in this analysis. Sociodemographic, clinical, antropometric, laboratorial, echocardiographic and functional data were abstracted from medical records. Psychosocial profile and quality of life were assessed using Hospital Anxiety and Depression Scale (clinical depression/anxiety if subscores ≥ 8) and short-form 36v2 (SF-36), respectively. A multivariable linear regression analyses was performed using end of PRC exercise testing duration in minutes as the dependent variable, adjusting for the duration of the baseline exercise stress test, and building a model by hierarchical inclusion of predictors identified in the univariate analysis. Results: From a total of 276 patients that completed CRP, 97(35,1%) were excluded due to incomplete data. Of the 179(54,2%) patients evaluated, 160(89,4%) were male, mean age of [mean(SD):53,5(9,8)] years and level of education of [P50(P25-75):6(4-12)] years. Among these, 30(16,8%) were diabetic; 32(17,9%) had previous history of coronary artery disease; 45(30%) were depressed, and the mean reported physical capacity perception, using the summary physical component of SF-36, was 46,6(7,7). Multivariate analysis identified male gender (p=0,008; β =0,12), level of education (p=0,007; β =0,144) and physical capacity perception (p=0,024; β =0,127) as positive predictor of functional capacity; whereas diabetes (p=0,005; β = -0,147), previous history of coronary artery disease (p= 0,019; β = -0,123) and depression (p=0,05; β = -0,102) had an inverse effect on functional status. Conclusion: Functional capacity in coronary heart disease patients is multifactorial and relies on a combination of clinical, psychosocial and socio-demographic characteristics. Specific strategies are needed to ensure adequate multidimensional/multiprofessional interventions in CRP instead of simple exercise based programs. Keywords: Coronary Disease/rehabilitation; Exercise Test; Exercise Tolerance.