Cardiac Rehabilitation And Quality Of Life Scores

AACVPR Cardiac Rehabilitation Risk Stratification Tool

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Cardiac Rehabilitation Risk Assessment

Enter the patient's clinical and exercise-test findings. Select “Not assessed / unknown” when information is unavailable.

PendingRisk class
1

Left Ventricular Ejection Fraction (LVEF)

Most recent clinically relevant resting LVEF, expressed as a percentage.

Leave blank if not available. AACVPR thresholds: less than 40%, 40–50%, and greater than 50%.

2

Previous Cardiac Arrest or Sudden Death

History of survival from cardiac arrest or sudden cardiac death.

3

Complex Ventricular Dysrhythmias

Examples include ventricular tachycardia or frequent (>6/min), multiform PVCs at rest or during exercise.

4

MI or Cardiac Surgery Complications

Complications include cardiogenic shock, congestive heart failure, and/or signs or symptoms of post-procedure ischemia.

Select the uncomplicated option only when the relevant event and absence of the complications above have been established.

5

Hemodynamic Response During Exercise and Recovery

Abnormal response includes a flat or decreasing systolic BP with increasing workload, chronotropic incompetence, or severe post-exercise hypotension.

6

Exercise ECG Response

Overall ECG response during exercise and recovery, apart from the silent ischemia ST-depression measurement below.

An abnormal ECG response that does not meet a separately specified AACVPR high-risk criterion prevents confirmation of the all-required low-risk category; it is not automatically assigned a higher category by this algorithm.

7

Silent Myocardial Ischemia

ST-segment depression during exercise or recovery without symptoms.

Enter 0 when no silent ischemia is documented. Leave blank if not assessed. Less than 2 mm is mild–moderate; 2 mm or greater is significant.

8

Angina or Other Exercise-Related Symptoms

Include angina, dizziness, lightheadedness, or unusual dyspnea during exercise or recovery.

The AACVPR algorithm lists symptoms during recovery among high-risk findings; the high-risk rule takes precedence.

9

Maximal Functional Capacity

Peak functional capacity measured during exercise testing.

Less than 5.0 METs is a high-risk criterion; at least 7.0 METs is required for the low-risk criterion. If unavailable, this variable is excluded as specified by AACVPR.

10

Clinical Depression or Depressive Symptoms

Clinically significant depression or depressive symptoms.

Complete the available clinical fields. The result will update automatically; unknown findings are not assumed to be absent.
—Risk class
AACVPR risk stratification
Assessment incomplete
Select or enter patient findings to determine the risk category.
Classification rationale

No classification has been generated yet.

    This algorithm stratifies risk of events and is not specific solely to exercise events.

    About AACVPR Risk Stratification

    The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) algorithm classifies patients into low-, intermediate-, or high-risk groups for cardiac events. It is intended to support clinical assessment in cardiac rehabilitation and is not a numerical point score.

    Classification rules

    Risk groupRuleSelected criteria
    HighAny one or more high-risk findingsLVEF <40%; cardiac arrest survivor; complex ventricular dysrhythmia; complicated MI/cardiac surgery; abnormal exercise hemodynamics; silent ST depression ≥2 mm; symptoms at <5 METs or during recovery; capacity <5 METs; clinically significant depression.
    LowAll low-risk criteriaLVEF >50%; no complex dysrhythmia; uncomplicated MI/revascularization without CHF or post-event ischemia; normal hemodynamic and ECG responses; asymptomatic; capacity ≥7 METs (if measured); no clinical depression.
    IntermediateNeither high nor all low criteriaLVEF 40–50%; symptoms at moderate workload or recovery; mild–moderate silent ischemia (ST depression <2 mm); or failure to meet all low-risk criteria without a high-risk finding.

    Important interpretation notes

    • High-risk criteria take precedence when more than one finding is present.
    • Low risk requires all low-risk criteria; absence of a documented high-risk feature alone is insufficient.
    • When functional capacity is not measured, AACVPR permits that variable to be excluded from stratification.
    • Missing clinical information is not treated as a negative finding. The tool may therefore return an indeterminate assessment rather than incorrectly assigning low risk.

    References

    American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).AACVPR Stratification Algorithm for Risk of Event. Copyright 2012; official AACVPR PDF version March 2014. Official algorithm (PDF).
    Silva AKF, Barbosa MPCR, Bernardo AFB, et al.Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols. Rev Bras Cir Cardiovasc. 2014;29(2):255–265. DOI: 10.5935/1678-9741.20140067.
    Brown TM, Pack QR, Beregg EL, et al.Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 2025;45(2):E6–E25. DOI: 10.1097/HCR.0000000000000930. This statement updates core program components and patient assessment; it is not the source of the AACVPR thresholds implemented above.
    Clinical disclaimer: This tool implements the published AACVPR risk-of-event algorithm as a decision-support aid. It does not replace comprehensive clinical assessment, exercise-test interpretation, physician judgment, or local cardiac rehabilitation protocols. A risk category is not a guarantee of an individual patient's event probability. Confirm data quality and clinical context before using the result to guide exercise prescription, supervision, or monitoring.
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