Die kardiologische Rehabilitation (KardReha) hat das Ziel, die individuell
bestmögliche physische und psychische Gesundheit kardiovaskulär erkrankter Patienten
durch die Therapie in einem multidisziplinären Team wiederherzustellen, nachhaltig
zu stabilisieren und die berufliche und soziale Re-Integration zu ermöglichen. Die
KardReha sollte daher integraler Bestandteil einer am langfristigen Erfolg
orientierten Behandlung sein [1]
[2]
[3]
[4].
Abstract
A scientific guideline has been developed to update and harmonize exercise based
cardiac rehabilitation (CR) in German speaking countries of Europe. It addresses all
aspects of CR including indications, contents and delivery. 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 systolic heart
failure (HFrEF), and to define the effect of psychological interventions during CR.
Other indications for CR were based on a predefined semi-structured literature
search and recommendations were established by a formal consenting process. CR is
associated with a significant reduction in all-cause mortality in patients after ACS
and CABG, whereas HFrEF-patients benefit in terms of exercise capacity and
health-related quality of life. Patients with other cardiovascular diseases such as
heart valve surgery or intervention, adults with congenital heart disease and
peripheral arterial disease 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,
modulation of cardiovascular risk factors, information and education, and a minimum
of individually adapted exercise volume. Additional psychologic interventions (PI)
should be performed on the basis of individual needs. There was a trend towards
reduction of depressive symptoms for “distress management” and “lifestyle changes”
for PI. Patient education is able to increase patients` knowledge and motivation as
well as behavior changes regarding physical activity, dietary habits and smoking
cessation. Diversity-sensitive structures should be established to interact with the
needs of special patient groups and gender issues. This guideline reinforces the
substantial benefit of CR in specific cardiac indications, and it points out the
minimal therapeutic needs in CR-delivery.
Schlüsselwörter
kardiologische Rehabilitation - Leitlinie - evidenzbasierte Medizin - koronare Herzkrankheit
- Herzinsuffizienz
Keywords
cardiac rehabilitation - guideline - evidence based medicine - coronary heart disease
- congestive heart failure
