@article{VoellerSalzwedelNitardyetal.2015, author = {V{\"o}ller, Heinz and Salzwedel, Annett and Nitardy, Aischa and Buhlert, Hermann and Treszl, Andras and Wegscheider, Karl}, title = {Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {22}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {5}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487314526072}, pages = {568 -- 574}, year = {2015}, abstract = {Background Transcatheter aortic-valve implantation (TAVI) is an established alternative therapy in patients with severe aortic stenosis and a high surgical risk. Despite a rapid growth in its use, very few data exist about the efficacy of cardiac rehabilitation (CR) in these patients. We assessed the hypothesis that patients after TAVI benefit from CR, compared to patients after surgical aortic-valve replacement (sAVR). Methods From September 2009 to August 2011, 442 consecutive patients after TAVI (n=76) or sAVR (n=366) were referred to a 3-week CR. Data regarding patient characteristics as well as changes of functional (6-min walk test. 6-MWT), bicycle exercise test), and emotional status (Hospital Anxiety and Depression Scale) were retrospectively evaluated and compared between groups after propensity score adjustment. Results Patients after TAVI were significantly older (p<0.001), more female (p<0.001), and had more often coronary artery disease (p=0.027), renal failure (p=0.012) and a pacemaker (p=0.032). During CR, distance in 6-MWT (both groups p0.001) and exercise capacity (sAVR p0.001, TAVI p0.05) significantly increased in both groups. Only patients after sAVR demonstrated a significant reduction in anxiety and depression (p0.001). After propensity scores adjustment, changes were not significantly different between sAVR and TAVI, with the exception of 6-MWT (p=0.004). Conclusions Patients after TAVI benefit from cardiac rehabilitation despite their older age and comorbidities. CR is a helpful tool to maintain independency for daily life activities and participation in socio-cultural life.}, language = {en} } @article{SkobelKamkeBoenneretal.2015, author = {Skobel, Erik and Kamke, Wolfram and B{\"o}nner, Gerd and Alt, Bernd and Purucker, Hans-Christian and Schwaab, Bernhard and Einwang, Hans-Peter and Schr{\"o}der, Klaus and Langheim, Eike and V{\"o}ller, Heinz and Brandenburg, Alexandra and Graml, Andrea and Woehrle, Holger and Kr{\"u}ger, Stefan}, title = {Risk factors for, and prevalence of, sleep apnoea in cardiac rehabilitation facilities in Germany: The Reha-Sleep registry}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {22}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {7}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487314537916}, pages = {820 -- 830}, year = {2015}, abstract = {Aim To determine the prevalence of, and the risk factors for, sleep apnoea in cardiac rehabilitation (CR) facilities in Germany. Methods 1152 patients presenting for CR were screened for sleep-disordered breathing with 2-channel polygraphy (ApneaLink; ResMed). Parameters recorded included the apnoea-hypopnoea index (AHI), number of desaturations per hour of recording (ODI), mean and minimum nocturnal oxygen saturation and number of snoring episodes. Patients rated subjective sleep quality on a scale from 1 (poor) to 10 (best) and completed the Epworth Sleepiness Scale (ESS). Results Clinically significant sleep apnoea (AHI 15/h) was documented in 33\% of patients. Mean AHI was 1416/h (range 0-106/h). Sleep apnoea was defined as being of moderate severity in 18\% of patients (AHI 15-29/h) and severe in 15\% (AHI 30/h). There were small, but statistically significant, differences in ESS score and subjective sleep quality between patients with and without sleep apnoea. Logistic regression model analysis identified the following as risk factors for sleep apnoea in CR patients: age (per 10 years) (odds ratio (OR) 1.51; p<0.001), body mass index (per 5 units) (OR 1.31; p=0.001), male gender (OR 2.19; p<0.001), type 2 diabetes mellitus (OR 1.45; p=0.040), haemoglobin level (OR 0.91; p=0.012) and witnessed apnoeas (OR 1.99; p<0.001). Conclusions The findings of this study indicate that more than one-third of patients undergoing cardiac rehabilitation in Germany have sleep apnoea, with one-third having moderate-to-severe SDB that requires further evaluation or intervention. Inclusion of sleep apnoea screening as part of cardiac rehabilitation appears to be appropriate.}, language = {en} } @article{SalzwedelWegscheiderHerichetal.2015, author = {Salzwedel, Annett and Wegscheider, Karl and Herich, Lena and Rieck, Angelika and Strandt, Gert and V{\"o}ller, Heinz}, title = {Impact of clinical and sociodemographic patient characteristics on the outcome of cardiac rehabilitation in older patients}, series = {Aging clinical and experimental research}, volume = {27}, journal = {Aging clinical and experimental research}, number = {3}, publisher = {Springer}, address = {New York}, issn = {1594-0667}, doi = {10.1007/s40520-014-0283-2}, pages = {315 -- 321}, year = {2015}, abstract = {Background Cardiac rehabilitation (CR) seeks to simultaneously improve several outcome parameters related to patient risk factors, exercise capacity and subjective health. A single score, the multiple outcome criterion (MOC), comprised of alterations in 13 outcome variables was used to measure the overall success of CR in an older population. As this success depends on the older patient's characteristics at the time of admission to CR, we attempted to determine the most important influences. Methods The impact of baseline characteristics on the success of CR, measured by MOC, was analysed using a mixed model for 1,220 older patients (70.9 +/- A 7.0 years, 78.3 \% men) who enrolled in 12 CR clinics. A multitude of potentially influential baseline patient characteristics was considered including sociodemographic variables, comorbidity, duration of hospital stay, exercise capacity, cardiovascular risk factors, emotional status, and laboratory and echocardiographic data. Results Overall, CR was successful, as indicated by the mean value of the MOC (0.6 +/- A 0.45; min -1.0, max 2.0; positive values denoting improvement, negative ones deterioration). Examples of association with negative MOC values included smoking (MOC -0.15, p < 0.001), female gender (MOC -0.07, p = 0.049), and a longer hospital stay (MOC -0.03, p = 0.03). An example of association with positive MOC value was depression score (MOC 0.06, p = 0.003). Further associations included maximal exercise capacity, blood pressure, heart rate and the rehabilitation centre attended. Conclusion Our results emphasize the necessity to take into consideration baseline characteristics when evaluating the success of CR and setting treatment targets for older patients.}, language = {en} } @article{ReibisHuberKaroffetal.2015, author = {Reibis, Rona Katharina and Huber, Matthias and Karoff, Marthin and Kamke, Wolfram and Kreutz, Reinhold and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Target organ damage and control of cardiovascular risk factors in hypertensive patients Evidence from the multicenter ESTher registry}, series = {Herz : cardiovascular diseases}, volume = {40}, journal = {Herz : cardiovascular diseases}, publisher = {Urban \& Vogel}, address = {M{\"u}nchen}, issn = {0340-9937}, doi = {10.1007/s00059-014-4189-8}, pages = {209 -- 216}, year = {2015}, abstract = {This study investigated the incidence of hypertensive target organ damage (TOD), control of cardiovascular risk factors, and the short-term prognosis in hypertensive patients under contemporary guideline-oriented therapy. A total of 1,377 consecutive patients (mean age 58.2 +/- 9.9 years, 82.2 \% male) with arterial hypertension were included in the ESTher (Endorganschaden, Therapie und Verlauf - target organ damage, therapy, and course) registry at 15 rehabilitation clinics within the framework of the National Genome Research Network. Cardiovascular risk factors, medication, comorbidities, and glomerular filtration rate (GFR) were assessed. Left ventricular hypertrophy (LVH), left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were determined by two-dimensional echocardiography. The mean follow-up was 513 +/- 159 days. Changes in continuous parameters were tested by the t test, changes in discrete characteristics are presented by means of transition tables and tested with the McNemar test. The mean LVEF was 59.3 +/- 9.9 \%, both mean LVM (238.6 +/- 101.5 g) and LVMI (54.0 +/- 23.6 g/m(2.7)) were increased while relative wall thickness (RWT, 0.46 +/- 0.18) indicated the presence of concentric LVH. Of the patients, 10.2 \% displayed renal dysfunction (estimated GFR < 60 ml/min/1.73 m(2)). The 1.5-year overall mortality was 1.2 \%. Compared with discharge, at follow-up the proportion of patients with blood pressure (BP) values < 140/90 mmHg decreased from 68.7 \% to 55.0 \% (p < 0.001) and with low-density lipoprotein (LDL) values < 100 mg/dl from 62.6 \% to 38.1 \% (p < 0.001). At follow-up significantly more patients displayed a GFR value of < 60 ml/min/1.73 m(2) (10.2 \% vs. 16.0 \%, p < 0.001). A significant proportion of hypertensive rehabilitation participants displayed TOD including LVH and renal dysfunction. Even after stringent BP reduction, a considerable increase in nephropathy could be found after 18 months.}, language = {en} } @misc{PiepoliCorraAbreuetal.2015, author = {Piepoli, Massimo F. and Corra, Ugo and Abreu, Ana and Cupples, Margaret and Davos, Costantinos and Doherty, Patrick and Hoefer, Stephan and Garcia-Porrero, Esteban and Rauchi, Bernhard and Vigorito, Carlo and V{\"o}ller, Heinz and Schmid, Jean-Paul}, title = {Challenges in secondary prevention of cardiovascular diseases A review of the current practice}, series = {International journal of cardiology}, volume = {180}, journal = {International journal of cardiology}, publisher = {Elsevier}, address = {Clare}, organization = {European Assoc Cardiovasc Preventi}, issn = {0167-5273}, doi = {10.1016/j.ijcard.2014.11.107}, pages = {114 -- 119}, year = {2015}, abstract = {With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care. (C) 2014 Elsevier Ireland Ltd. All rights reserved.}, language = {en} }