Laíza Delatorre Mardegan Borges, Jéssica Malek da Silva, Kemilly Pereira Florêncio, Maria Fernanda de Souza Moreno Lopes, Letícia Soares Alves, Maria Clara de Souza Moreno Lopes, Carlos Eduardo da Costa Nunes Bosso, Luiz Carlos Marques Vanderlei
The findings provide preliminary evidence regarding the agreement and reproducibility of the 2020 Brazilian Society of Cardiology protocol compared with established cardiac rehabilitation programs protocols; however, further studies are needed to evaluate its predictive validity for exercise-related events.
BACKGROUND: Cardiac risk stratification protocols are widely used in cardiac rehabilitation programs, but divergent classifications limit their applicability. In 2020, the Brazilian Society of Cardiology updated its protocol; however, its agreement with established protocols and inter-rater reliability in cardiac rehabilitation programs remain unclear.
OBJECTIVE: The aim of this study was to evaluate the agreement between the 2020 Brazilian Society of Cardiology cardiac risk stratification protocol and protocols used in clinical practice and to assess inter-rater agreement in its application.
DESIGN AND SETTING: Cross-sectional observational study conducted in a cardiac rehabilitation program at a public university in Brazil.
METHODS: Medical records of 51 cardiac rehabilitation programs participants were independently analyzed by two cardiovascular physical therapists using the 2020 Brazilian Society of Cardiology, American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine, Pashkow, and 2013 Brazilian Society of Cardiology protocols. Agreement between protocols and inter-rater reliability was assessed using the Kappa coefficient.
RESULTS: The 2020 Brazilian Society of Cardiology protocol showed moderate agreement with Pashkow (k=0.544; 95%CI 0.340-0.748; p<0.001) and the 2013 Brazilian Society of Cardiology protocol (k=0.708; 95%CI 0.498-0.918; p<0.001), good-to-excellent agreement with American Association of Cardiovascular and Pulmonary Rehabilitation (k=0.780; 95%CI 0.604-0.956; p<0.001), and weak, nonsignificant agreement with American College of Sports Medicine (k=0.003; 95%CI -0.015 to 0.021 p=0.866). Inter-rater analysis demonstrated excellent agreement between evaluators (k=0.843; 95%CI 0.672-1.014; p<0.001).
CONCLUSION: The findings provide preliminary evidence regarding the agreement and reproducibility of the 2020 Brazilian Society of Cardiology protocol compared with established cardiac rehabilitation programs protocols; however, further studies are needed to evaluate its predictive validity for exercise-related events.