Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

Journal of Clinical Medicine

卷:10

on behalf of the Cardiac Rehabilitation Guideline Group¹  Gesine Dörr²  Maria-Inti Metzendorf³  Bernhard Schwaab⁴  Karl-Heinz Ladwig⁵  Christian Albus⁶  Heinz Völler⁷  Annett Salzwedel⁷  Sarah Eichler⁷  Susanne Weinbrenner⁸  Johannes Falk⁸  Uwe Nixdorff⁹  Roland Nebel¹⁰  Ronja Westphal¹¹  Bernhard Rauch¹²  Karin Meng¹³  Kurt Bestehorn¹⁴  Birna Bjarnason-Wehrens¹⁵  Rhoia Clara Neidenbach¹⁶  Katrin Jensen¹⁷  Daniel Saure¹⁷  Matthes Hackbusch¹⁷  Rona Reibis¹⁸  Jean-Paul Schmid¹⁹  Hans-Peter Einwang²⁰  Christa Bongarth²⁰  Wolfgang Mayer-Berger²¹  Harald Kaemmerer²²  Matthias Hermann²³  Roland von Känel²⁴  Stephan Gielen²⁵  Renate Oberhoffer²⁶  Axel Schlitt²⁷  Werner Benzer²⁸  Johannes Glatz²⁹  Manju Guha³⁰  Johann Altenberger³¹  Nils Reiss³²  Maurizio Grilli³³  Josef Niebauer³⁴  Stefan Höfer³⁵  Eike Hoberg³⁶  Nicola Benjamin³⁷  Ekkehard Grünig³⁷ 

[1] ;

[2] Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;

[3] Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;

[4] Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;

[5] Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;

[6] Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;

[7] Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany;

[8] Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany;

[9] EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;

[10] Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;

[11] Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;

[12] Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany;

[13] Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;

[14] Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;

[15] Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;

[16] Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;

[17] Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany;

[18] Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;

[19] Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland;

[20] Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany;

[21] Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;

[22] Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;

[23] Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;

[24] Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;

[25] Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;

[26] Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;

[27] Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;

[28] Reha-Klinik Montafon, A-6780 Schruns, Austria;

[29] Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;

[30] Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;

[31] Rehabilitationszentrum Großgmain, A-5084 Großgmain, Austria;

[32] Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;

[33] Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;

[34] Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;

[35] Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;

[36] Wismarstraße 13, D-24226 Heikendorf, Germany;

[37] Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany;

关键词: cardiac rehabilitation standards;    scientific guidelines;    secondary prevention;    coronary artery disease;    chronic heart failure;    heart valve repair;   

DOI  :  10.3390/jcm10102192

来源: DOAJ

【 摘 要 】

Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.

【 授权许可】

Unknown