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Background Exercise training is worldwide recommended to treat patients with heart disease, but sometimes, it can trigger adverse outcomes (ischemia, arrhythmias or sudden death). Several clinical tools are used to stratify patients, usually developed by expert consensus without any clinical validation during exercise sessions. Purpose The aim of this study was to develop up and validate a contemporary risk stratification calculator to identify patients at high risk of adverse outcomes during physical training. Methods A cohort of patients with heart disease that participated in a cardiac rehabilitation program were studied. A data base was constructed using several variables of interest derived from clinical records, patient evaluations, paraclinical reports along with stress testing. All patients participated in an ambulatory hospital-based cardiac rehabilitation program. Every patient exercised 5 times a week, 30 minutes continuously at a moderate-intensity, using a high-tech cyclergometer. Aerobic training was complemented with a three times a week, general gymnastics circuit. All sessions were highly supervised by trained personal, including a cardiologist. Major outcome variables were sudden death, coronary acute syndrome, syncope or stroke. Minor outcomes were any kind of arrhythmia and the presence of ischemia (angina or ST depression). Nominal, categorical or numerical variables were presented as appropriate. A bivariate analysis was performed. Those statistically significant variables (p Results A total of 639 patients were included, and no major adverse outcome occurred. Seventy six percent of patients presented arrhythmias and 5% showed ischemia. Seventeen stochastically significant variables were obtained from clinical records and paraclinical tests, and were included in two multivariable models, focusing on arrhythmia (EXERISK-A) or ischemia (EXERISK-I). After analysis, three variables remained associated with arrhythmia (maximal METs, left ventricle ejection fraction and frequent premature ventricular complexes) and three with ischemia (history of angina, METs and SYNTAX score). Once logistic equations were obtained, traditional risk-stratification scales were applied to the sample. Figure 1 shows ROC curve comparison of both models with traditional stratification scales. The area under the curve was 0.730 (EXERISK-A) and 0.856 (EXERISK-I) EXERISK Conclusion Exercise-induced arrhythmias are a very common finding in patients with heart disease, few patients showed ischemia and no mayor adverse cardiovascular outcomes were demonstrated. Both risk stratification models (EXERISK-A and EXERISK-I), can accurately predict arrhythmias or ischemia in a simple and rapid fashion.

Introduccion y objetivos La disfuncion erectil es frecuente en pacientes con cardiopatia. Analizamos la incidencia, los factores etiologicos y los resultados obtenidos en el tratamiento de esta afeccion en pacientes incluidos en un programa de rehabilitacion cardiaca. Metodos Se estudio a 420 varones cardiopatas sometidos a una terapia multifactorial de entrenamiento fisico, actuacion psicologica y control de factores de riesgo. Resultados Tuvieron disfuncion erectil 216 (52,6%) pacientes, en clara relacion con edad (p Conclusiones La incidencia de disfuncion erectil es muy significativa. Se relaciona con los factores de riesgo de aterosclerosis, con el tratamiento y con anomalias psicologicas (ansiedad y depresion). El miedo a las complicaciones y las malas relaciones de pareja puede favorecer que muchos pacientes declinen tomar inhibidores de la fosfodiesterasa.

Erectile dysfunction is common in patients with coronary heart disease. The aim of this study was to investigate the incidence of, etiological factors associated with, and treatment results obtained in this condition in patients participating in a cardiac rehabilitation program.The study included 420 male patients with heart disease who were taking part in a multicomponent therapeutic program that involved physical exercise, psychological techniques and risk factor reduction.Overall, erectile dysfunction was present in 216 patients (52.6%) and there were clear associations with age (P.001), diabetes mellitus (P.001), arterial hypertension (P=.029), cigarette smoking (P=.044) and treatment with angiotensin-converting enzyme inhibitors (P=.003) and diuretics (P.001). However, there were no links to treatment with beta-blockers, calcium antagonists, statins or antiplatelet agents. There were direct associations with trait anxiety (P=.009) and state anxiety (P=.006) and with depression (P=.003). The final multivariate analysis model included diabetes mellitus, smoking, diuretic use, state anxiety and age as significant variables. Only 59 patients agreed to treatment with a phosphodiesterase-5 inhibitor, with positive results in 45 (76.27%). Treatment was contraindicated in 41 patients because they were taking nitrates for myocardial ischemia. The remaining patients expressed no interest, had relationship problems or were worried about complications.The incidence of erectile dysfunction was substantial. The condition was directly associated with risk factors for atherosclerosis, treatment, and psychological disorders (i.e., anxiety and depression). Relationship problems and the fear of complications may explain why many patients refused to take phosphodiesterase-5 inhibitors.