TITLE: A Critical Understanding Of Issues Surrounding Pre-participation Risk Stratification In

Cardiac Patients Undertaking Exercise Rehabilitation In The United Kingdom

Pre-participation risk stratification in cardiac patients is the process which assists in evaluating
the level of risk associated with exercise or physical activity for people with known or unknown
cardiovascular diseases. The purpose for this is to ascertain if a patient can fully and safely
participate in exercise and also establish appropriate protocols for their activity level and
participation. In the United Kingdom, this process follows established guidelines and protocols
with a notable focus on patient safety (British Association for Cardiovascular Prevention and
Rehabilitation,2017). It involves a detailed evaluation of a medical history, diagnostic tests such
as stress test and cardiac imaging are performed. This helps to categorize patients into low,
moderate or high risk. It promotes a tailored intervention for each patient.
One may ask is pre-participation risk stratification important and if yes, Why? “A pre-
participation risk stratification before cardiac rehabilitation is mandatory and important in order
to deliver a safe programme tailored to the individual patient. This initial evaluation also aims to
increase patient adherence and the efficiency of the programme. (Ilou et al, Oxford medicine
online, 2020). As much as pre-participation risk stratification is important and parameters have
been set to ensure a safe programme tailored to the individual there are issues surrounding it
affecting its execution effectively in the United Kingdom.
CONTROVERSY:
First and foremost, one major issue revolves around how accurate or reliable the tools and
guidelines used in pre-participation risk stratification is. How suitable are the risk scores and
guidelines developed for different populations and individual patients in the United Kingdom.
There could be 1% of the population as we may not see it as significant, but what if in a year that
whole 1% need exercise rehabilitation and could not positively benefit from these guidelines.
This could lead to patients who could have gained help from exercise rehabilitation and would be
at risk of unfavourable events. It also needs to be taken in account that Cardiac rehabilitation
guidelines are subject to periodic updates, making it very important and mandatory for healthcare
professionals to stay informed about latest recommendations(BACPR,2017). This update could
assist in refreshing the guidelines and tools to assist different populations in the country.
CHALLENGES
Furthermore, in the early initial assessment process, the result of the process is heavily
dependent on what the patient reports ( The BACPR standards and core components for
cardiovascular disease prevention and rehabilitation, 2017), especially in healthcare facilities
where resources such as diagnostic tests to support the data given by patients are not available.
What the patient says cannot solely be depended on due to factors such as anxiety and
misunderstanding. Objective test may not always be practical leading to potential
misclassification.
In addition, promoting transparency between patients and healthcare professionals about
limitations in the pre participation risk stratification has become an issue. Certain times striking a
balance between benefits of exercise rehab and the risk of adverse events can be challenging for
health professionals. It is crucial to ensure that patient autonomy and well-being are respectd
while prioritizing patient safety. Including patients in decision making process and adequately
educating them about the potential risks and benefits of exercise rehabilitation is essential ( Naci
et al, British Journal Of Sports Medicine, 2019).
The accessibility and availability of resources for risk stratification pose practical difficulties.
One of the most important resource needed for effective risk stratification is a qualified
healthcare team. The lack of trained healthcare team leads to assessment delaying posing a risk
to the patient. Diagnostic test such as stress test, echocardiography plays a major role in getting
accurate results to help in the assessment process. In facilities whereby these tests are not readily
available it leads to healthcare professionals depending solely on what the patient says, which
cannot be fully depended on due to misunderstanding and anxiety. In addition, resource
limitations lead to patients follow up being inadequate. Inadequate resources make it challenging
to ensure continuous supervision to make necessary adjustments to exercise plan.
In conclusion, pre-participation risk stratification is an important process in guiding exercise
rehabilitation for cardiac patients in the United Kingdom. As it aims to enhance patient safety
and optimize outcomes and results, there are issues that need to be assessed and improved upon.
These include the lack of adequate resources, the reliability and accuracy of tools and guidelines
used in pre-participation risk stratification and the process of getting inadequate report from
patients. Critically examining these issues, it is imperative that institutions and healthcare
workers come together to improve the reliability and stability of pre-participation risk
stratification to effectively enhance the well-being of cardiac patients undergoing rehabilitation
in the United Kingdom.