Efeitos e segurança da reabilitação cardíaca precoce sobre a função cardíaca e aptidão física após infarto agudo do miocárdio

Abstract

Introduction: Exercise-based cardiac rehabilitation (CR-ex) is a non-drug procedure already clinically incorporated with a grade AI recommendation for patients after acute myocardial infarction (AMI) in the outpatient phase. Despite the scientific growth of RC-ex in the hospital phase and early after the event, its efficacy and safety require clarification with more robust methodological designs. Objective: To analyze the effectiveness of a CR-ex protocol on physical fitness and cardiac function, in addition to cardio hemodynamic safety after recent AMI. Materials and methods: Inpatients with AMI and successful percutaneous coronary intervention (PCI) were included in the clinical trial and randomized into two groups: Intervention Group (IG) and Control Group (CG). Both groups received the initial phase of inhospital RC-ex, optimized drug treatment and guidance for self-managed ambulation, however, the GI continued RC-ex with progression in the in-hospital phase and the semi-supervised home phase. Participants underwent the same clinical and functional assessments, with maximal and submaximal physical effort tests (ergometric test and 30s sit-to-stand test) and analysis of heart rate variability (HRV). Results: Chapter 1 presents the publication and detailed description of the clinical trial protocol. Chapter 2 confirms the validation of the theoretical content of the RC-ex protocol with a content validation coefficient of 0.80. In Chapter 3, the longitudinal analysis carried out during the pilot study found low rates of adverse events in 131 RC-ex sessions, even with significant increases in heart rate, systolic blood pressure and the double product, immediately after the sessions. Chapter 4 describes the clinical trial that showed a significant increase in HRV indices in the GI compared to the CG in the reevaluation. Physical fitness assessed by the ET (Ergometric Test) showed an increase of 2.07 MET's in the IG compared to the CG, however, without a statistically significant difference. The 30s Sit and Stand Test (TSL 30s) showed a similar increase between the groups with no statistical difference. Conclusion: RC-ex with an estimated final dose of 845 MET-min after AMI was effective in improving cardiac autonomic balance. This study provides important guidance on the safe and effective therapeutic window for early CR-ex in patients with AMI.