‘PERFSCORE’ – a multidimensional score: a simple way to predict the success of cardiac rehabilitation Patrizia Maras a , Sara Doimo a , Alessando Altinier a , Alessio Della Mattia a , Luigia Scudeller b , Gianfranco Sinagra a and Catherine Klersy b Background We propose a simple and reliable score, performance score (‘PERFSCORE’), that allows cardiologists to assess the achievement of therapeutic goals. Methods We identified six indicators of cardiac rehabilitation performance: heart rate (HR) less than 70 beats/min; blood pressure (BP) less than 140/90 mmHg; smoking cessation or non-smokers; left ventricular ejection fraction (LVEF) more than 40%; LDLc less than 100 mg/dl or more than 70 mg/dl if diabetic; and on treatment at least with three drugs among angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blocker (ARBs), b- blockers, statins, and ASA. These six indicators are considered to be the collective expression of a latent variable measuring performance. To assess the relative contribution of each indicator in the definition of cardiac rehabilitation performance, we fitted a structural equation model using the ‘Stata 13’ system. Results A total of 839 consecutive patients were analyzed; 49% had recent ST- elevation myocardial infarction/non-ST elevation myocardial infarction and 51% had undergone elective percutaneous coronary intervention/coronary artery bypass graft. At the end of cardiac rehabilitation, LVEF was 55 W 11%; HR, 69 W 13 beats/min; SBP, 135 W 20 mmHg; DBP, 79 W 10 mmHg; LDLc, 88 W 29 mg/dl; 56% had stopped smoking; 71% were on b-blockers; 78% ACE inhibitors or ARBs; 87% were on statins, and 96% were on ASA. Weights for each indicator in the PERFSCORE were 0.57 for HR, 0.40 for BP, 0.87 for LVEF, 0.78 for smoking, 0.42 for LDLc, and 0.75 for drugs, multiplied by 1 if the target has been reached, otherwise by 0. Higher performance values correspond to better cardiac rehabilitation results. The point range was 0–36: less than 24, not satisfying cardiac rehabilitation; 24–29, satisfying cardiac rehabilitation; and more than 29, optimal cardiac rehabilitation. Conclusion In conclusion, we propose an easy algorithm to calculate the success of cardiac rehabilitation. J Cardiovasc Med 2017, 18:000–000 Keywords: cardiac rehabilitation, coronary artery disease, performance measures, score, secondary prevention, outcome a Cardiovascular Department, ‘Ospedali Riuniti’ of Trieste and Postgraduate School Cardiovascular Sciences, University of Trieste, Trieste and b Service Biometry & Statistics, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy Correspondence to Sara Doimo, MD, Piazza dell’Ospitale 2/1, 34125, Trieste, Italy. Tel: +040 399 2908; fax: +040 399 2298; e-mail: sarozza@gmail.com Received 5 October 2016 Revised 31 January 2017 Accepted 19 February 2017 Introduction Recent guidelines on acute coronary syndrome (ACS) and coronary revascularization recommend all patients after ACS, coronary revascularization and stable angina should be referred for cardiac rehabilitation, 1–3 a multi- disciplinary treatment with proven efficacy in the control of cardiovascular risk factors, reduction in cardiovascular mortality and in the maintenance and optimization of recommended pharmacological therapy 4–8 To our best knowledge, no comprehensive indicator of cardiac rehabilitation performance is available for cardi- ologists to assess the efficacy of the program, and they will commonly rely on a series of indicators listed in literature, including adherence to guideline-based therapies, achievement, and maintenance of clinical targets and risk factor management. The aim of our study is to evaluate the performance of cardiac rehabilitation in patients who had undergone coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) with or without valvular surgery, after ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), ACS, or elec- tive PCI, by combining an array of indicators in a multidimensional approach. Methods From January 2009 to 2010 our center collected, in a prospective registry, 839 consecutive patients discharged from our cardiovascular department after acute myo- cardial infarction, PCI or CABG and enrolled in a pro- gram of ambulatory cardiac rehabilitation and secondary prevention. Patients who were not residents in our region or with severe non-cardiac comorbidities have been excluded. The patients are enrolled early after discharge: STEMI and CABG patients are convened to the first evaluation within 2 weeks, whereas NSTEMI and PCI in 4–5 weeks. The patients with NSTEMI or PCI receive Original article 1558-2027 ß 2017 Italian Federation of Cardiology. All rights reserved. DOI:10.2459/JCM.0000000000000518 © 2017 Italian Federation of Cardiology. All rights reserved.