Risk Stratification

 

     When a person begins a program it is important to determine how that person’s heart will respond to exercise.  Whether a new patient is entering the Center for Cardiac Fitness for cardiac rehab, pulmonary rehab, or maintenance, they a heart monitor is used to constantly observe their heart rhythm.  The frequency each person will wear this heart monitor is based on the individual’s medical history and current medical conditions.  This section will outline The Miriam Hospital’s Center for Cardiac Fitness’s guidelines for heart monitoring that include with risk stratification methods.

     Risk stratification is based on different criteria depending upon the program a patient enters.  This method is used as a way of tracking how often each person is monitored with the heart monitors to ensure that there are no cardiac related problems arising when they exercise.  There are three levels of risk: high, moderate, and low.  If a person is considered high risk, then based on their past medical history and current conditions there is a greater likelihood for them to experience an emergency during exercise sessions than a person of moderate or low risk.  The frequency a patient is monitored during a cardiac rehab class cycle (36 sessions total) is as follows:

 

View the attached PDF to see the criteria used to risk stratify cardiac rehab patients.

 

Risk            Monitored Sessions          Distribution of Monitored Sessions

High            18                                    1st 10 sessions then 1/week

Moderate      12                                   1st 7 sessions then during weeks 4,5,7,9,12

Low              8                                    1st 4 sessions then during weeks 3,5,8,12

 

     Another program people enter at the Center for Cardiac Fitness is the pulmonary rehab program.  The method of risk stratification serves the same purpose for these people, but the criteria are different.  The criteria and frequency a patient is monitored based on their risk is as follows:

 

Risk           Criteria                                                                                                    Monitored sessions

Level 1       No cardiac disease, normal EKG, normal baseline telemetry                        1st day, midpoint, discharge

Level 2       Abnromal EKG, cardiac hx > 2 yrs, EF 40-49%, mildly positive stress test    1st day, visit 6,12,18,32, discharge

                  (<2 mm ST depression, or mild-moderate defect)

Level 3       Cardiac hx <2 yrs, EF <40%, or strongly ischemic stress test (>2 mm ST      1st day, visit 4, 8, 16, 20, 28, 32, d/c                     depression or large reversible defect)

 

     Finally, the last group of people that is monitored periodically are the people entering the maintenance program.   The maintenance program provides those who have graduated from a rehabilitation class to continue their exercising in a controlled environment where the staff is trained for emergency situations.  This can give people the peace of mind that they are safer there compared to the average fitness club they might join do complete their exercise at, not only because of the training the staff has but also because their vital signs and heart rhythms are monitored as needed.  The monitoring schedule for this program is as follows:

 

View the attached PDF to see the criteria used to risk stratify cardiac maintenance patients.

 

Risk            Frequency of Monitored Sessions

High            Every other month

Moderate     2 times per year

Low            2 times per year

 

 

     Risk stratification is an important tool used to ensure the safety of everyone who participates in a program at the Center for Cardiac Fitness, which is an important priority at the facility.