1. RISK STRATIFICATION

2. Established by the CACR in Sept. 1999 National Guidelines Committee The committee acknowledged the support of the Canadian Cardiovascular Society, the Heart and Stroke Foundation of Canada and the American Association of Cardiovascular and Pulmonary Rehabilitation Risk Stratification Guidelines

3. Changing populations Increased number of patients with Congestive Heart Failure Recognition that the greater number of risk factors the greater the risk Advancements in vascular biology 1995 Bethesda Conference: Matching the Intensity of Risk Factor Management/Intervention with The Hazard for Cardiovascular Disease Events Cardiac Rehabilitation is Changing

4. Risk of Disease Progression + Risk of Acute Cardiac Event = Total Patient’s Score Determination of Overall Risk

5. Risk of Disease Progression - Long Term Absolute Risk Age Lipid Profile Blood Pressure Diabetes Psychological Issues Smoking

6. Risk of Cardiovascular Disease Prognosis- Short Term Absolute Risk Functional Capacity Left Ventricular Ejection Fraction (%) Ischemic Burden Dysrythmias

7. Risk of Cardiovascular Disease Prognosis- Short Term Absolute Risk Functional Capacity -measure from results of treadmill stress test, Bruce Protocol most common

8. Risk of Cardiovascular Disease Prognosis- Short Term Absolute Risk Left Venticular Ejection Fraction (%) -results from an angiogram or echocardiogram

9. Risk of Cardiovascular Disease Prognosis- Short Term Absolute Risk Ischemic Burden - Canadian Cardiovascular Society angina scales - Treadmill Test - Myocardial Perfusion Imaging

10. Risk of Cardiovascular Disease Prognosis- Short Term Absolute Risk Dysrythmias -stress tests -history from hospitaizations -12 lead ECG -holter monitor reports

11. Determination of Overall Risk DiseaseAcute Total Prog.Event Low to<7<7 <14 Moderate High 7 - 147 - 14 >14 Very High>14>14 >28

12. What does this tell us? Exercise tolerance Risk factor teaching Patient follow up