Approach To Risk Stratification

In this chapter we deliberate over current patient assessment procedures for entry into CR programmes. We do not attempt to describe the ultimate blueprint for the risk stratification and assessment of patients for the exercise component. Nonetheless, we discuss current accepted practice and explore the evidence to support it. In addition, we will describe a fresh approach proposed by the Canadian Association of Cardiac Rehabilitation (Stone, et al., 2001) for effectively determining a patient's risk of exercise-related cardiac events. The chapter will explore the variety of different processes and approaches used to understand assessment and risk stratification and the characteristics of each including pros and cons.

Exercise Leadership in Cardiac Rehabilitation. An Evidence-Based Approach. Edited by Morag Thow. Copyright 2006 by John Wiley & Sons Ltd. ISBN 0-470-01971-9

Risk stratification can be considered as the crux of assessment prior to entry into CR, but this approach should form part of a process of sound clinical reasoning. The reader will find reference to commonly used coronary heart disease (CHD) risk-stratification guidelines for supervised exercise. These guidelines are produced by authoritative organisations well respected in this field - American Heart Association (AHA, 2001), SIGN (2002) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR, 2004).

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