@article{SalzwedelHeidlerMengetal.2020, author = {Salzwedel, Annett and Heidler, Maria-Dorothea and Meng, Karin and Schikora, Martin and Wegscheider, Karl and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {26}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {1}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487318791609}, pages = {46 -- 55}, year = {2020}, abstract = {Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80\% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients' disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients' cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed.}, language = {en} } @article{MainkaWisselVoelleretal.2018, author = {Mainka, Stefan and Wissel, J{\"o}rg and V{\"o}ller, Heinz and Evers, Stefan}, title = {The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients}, series = {Frontiers in Neurology}, volume = {9}, journal = {Frontiers in Neurology}, publisher = {Frontiers Research Foundation}, address = {Lausanne}, issn = {1664-2295}, doi = {10.3389/fneur.2018.00755}, pages = {8}, year = {2018}, abstract = {The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SR The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 +/- 8.6 years, mean time between stroke and start of study 42.1 +/- 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F-(2,F- (34)) = 3.864, p = 0.032; partial eta(2) = 0.205] and cadence [F-(2,F- 34) = 7.656, p = 0.002; partial eta(2) = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.}, language = {en} } @article{HansenAbreuDohertyetal.2019, author = {Hansen, Dominique and Abreu, Ana and Doherty, Patrick and V{\"o}ller, Heinz}, title = {Dynamic strength training intensity in cardiovascular rehabilitation: is it time to reconsider clinical practice? A systematic review}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {26}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {14}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487319847003}, pages = {1483 -- 1492}, year = {2019}, abstract = {When added to endurance training, dynamic strength training leads to significantly greater improvements in peripheral muscle strength and power output in patients with cardiovascular disease, which may be relevant to enhance the patient's prognosis. As a result, dynamic strength training is recommended in the rehabilitative treatment of many different cardiovascular diseases. However, what strength training intensity should be selected remains under intense debate. Evidence is nonetheless emerging that high-intensity strength training (≥70\% of one-repetition maximum) is more effective to increase acutely myofibrillar protein synthesis, cause neural adaptations and, in the long term, increase muscle strength, when compared to low-intensity strength training. Moreover, multiple studies report that high-intensity strength training causes fewer increments in (intra-)arterial blood pressure and cardiac output, as opposed to low-intensity strength training, thus potentially pointing towards sufficient medical safety for the cardiovascular system. The aim of this systematic review is therefore to discuss this line of evidence, which is in contrast to current clinical practice, and to re-open the debate as to what dynamic strength training intensities should actually be applied.}, language = {en} } @article{EichlerRabeSalzwedeletal.2017, author = {Eichler, Sarah and Rabe, Sophie and Salzwedel, Annett and Mueller, Steffen and Stoll, Josefine and Tilgner, Nina and John, Michael and Wegscheider, Karl and Mayer, Frank and V{\"o}ller, Heinz}, title = {Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: study protocol for a multicenter, superiority, no-blinded randomized controlled trial}, series = {Trials}, volume = {18}, journal = {Trials}, publisher = {BioMed Central}, address = {London}, issn = {1745-6215}, doi = {10.1186/s13063-017-2173-3}, pages = {7}, year = {2017}, abstract = {Background: Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design: This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion: We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.}, language = {en} } @article{AlgharablyBolbrinkerLeziusetal.2017, author = {Algharably, Engi A. H. and Bolbrinker, Juliane and Lezius, Susanne and Reibis, Rona Katharina and Wegscheider, Karl and V{\"o}ller, Heinz and Kreutz, Reinhold}, title = {Uromodulin associates with cardiorenal function in patients with hypertension and cardiovascular disease}, series = {Journal of hypertension}, volume = {35}, journal = {Journal of hypertension}, publisher = {Lippincott Williams \& Wilkins}, address = {Philadelphia}, issn = {0263-6352}, doi = {10.1097/HJH.0000000000001432}, pages = {2053 -- 2058}, year = {2017}, abstract = {Objective:Common genetic variants in the gene encoding uromodulin (UMOD) have been associated with renal function, blood pressure (BP) and hypertension. We investigated the associations between an important single nucleotide polymorphism (SNP) in UMOD, that is rs12917707-G>T, and estimated glomerular filtration rate (eGFR), BP and cardiac organ damage as determined by echocardiography in patients with arterial hypertension.Methods:A cohort of 1218 treated high-risk patients (mean age 58.5 years, 83\% men) with documented cardiovascular disease (81\% with coronary heart disease) was analysed.Results:The mean values for 24-h SBP and DBP were 124.714.7 and 73.9 +/- 9.4mmHg; mean eGFR was 77.5 +/- 18.3ml/min per 1.73m(2), mean left ventricular ejection fraction was 59.3 +/- 9.9\% and mean left ventricular mass index in men and women was 53.9 +/- 23.2 and 54.9 +/- 23.7g/m(2.7) with 50.4\% of patients having left ventricular hypertrophy. A significant association between rs12917707 and eGFR was observed with T-allele carriers showing significantly higher eGFR values (+2.6ml/min per 1.73m(2), P=0.006) than noncarriers. This SNP associated also with left atrial diameter (P=0.007); homozygous carriers of the T-allele had smaller left atrial diameter (-1.5mm) than other genotype groups (P=0.040). No significant associations between rs12917707 and other cardiac or BP phenotypes were observed.Conclusions:These findings extend the previously documented role of UMOD for renal function also to treated high-risk patients with arterial hypertension and reveal a novel association with left atrial remodelling and thus a potential cardiorenal link modulated by UMOD.}, language = {en} } @article{SalzwedelReibisHeidleretal.2019, author = {Salzwedel, Annett and Reibis, Rona Katharina and Heidler, Maria-Dorothea and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Determinants of Return to Work After Multicomponent Cardiac Rehabilitation}, series = {Archives of Physical Medicine and Rehabilitation}, volume = {100}, journal = {Archives of Physical Medicine and Rehabilitation}, number = {12}, publisher = {Elsevier}, address = {Philadelphia}, issn = {0003-9993}, doi = {10.1016/j.apmr.2019.04.003}, pages = {2399 -- 2402}, year = {2019}, abstract = {Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80\% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95\% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95\% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95\% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95\% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95\% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95\% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95\% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95\% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect.}, language = {en} } @misc{SalzwedelVoellerReibis2019, author = {Salzwedel, Annett and V{\"o}ller, Heinz and Reibis, Rona Katharina}, title = {Vocational reintegration in coronary heart disease patients - the holistic approach of the WHO biopsychosocial concept}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {26}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {13}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487319850699}, pages = {1383 -- 1385}, year = {2019}, language = {en} } @article{SalzwedelKoranLangheimetal.2020, author = {Salzwedel, Annett and Koran, Iryna and Langheim, Eike and Schlitt, Axel and Nothroff, J{\"o}rg and Bongarth, Christa and Wrenger, Markus and Sehner, Susanne and Reibis, Rona Katharina and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Patient-reported outcomes predict return to work and health-related quality of life six months after cardiac rehabilitation}, series = {PLoS ONE}, volume = {15}, journal = {PLoS ONE}, number = {5}, publisher = {Plos 1}, address = {San Francisco}, issn = {1932-6203}, doi = {10.1371/journal.pone.0232752}, pages = {17}, year = {2020}, abstract = {Background Multi-component cardiac rehabilitation (CR) is performed to achieve an improved prognosis, superior health-related quality of life (HRQL) and occupational resumption through the management of cardiovascular risk factors, as well as improvement of physical performance and patients' subjective health. Out of a multitude of variables gathered at CR admission and discharge, we aimed to identify predictors of returning to work (RTW) and HRQL 6 months after CR. Design Prospective observational multi-centre study, enrolment in CR between 05/2017 and 05/2018. Method Besides general data (e.g. age, sex, diagnoses), parameters of risk factor management (e.g. smoking, hypertension), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance) and patient-reported outcome measures (e.g. depression, anxiety, HRQL, subjective well-being, somatic and mental health, pain, lifestyle change motivation, general self-efficacy, pension desire and self-assessment of the occupational prognosis using several questionnaires) were documented at CR admission and discharge. These variables (at both measurement times and as changes during CR) were analysed using multiple linear regression models regarding their predictive value for RTW status and HRQL (SF-12) six months after CR. Results Out of 1262 patients (54±7 years, 77\% men), 864 patients (69\%) returned to work. Predictors of failed RTW were primarily the desire to receive pension (OR = 0.33, 95\% CI: 0.22-0.50) and negative self-assessed occupational prognosis (OR = 0.34, 95\% CI: 0.24-0.48) at CR discharge, acute coronary syndrome (OR = 0.64, 95\% CI: 0.47-0.88) and comorbid heart failure (OR = 0.51, 95\% CI: 0.30-0.87). High educational level, stress at work and physical and mental HRQL were associated with successful RTW. HRQL was determined predominantly by patient-reported outcome measures (e.g. pension desire, self-assessed health prognosis, anxiety, physical/mental HRQL/health, stress, well-being and self-efficacy) rather than by clinical parameters or physical performance. Conclusion Patient-reported outcome measures predominantly influenced return to work and HRQL in patients with heart disease. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption.}, language = {en} } @article{VoellerHeyne2020, author = {V{\"o}ller, Heinz and Heyne, Karen}, title = {Evaluation of the Accuracy of the LumiraDx INR Test Using Patients in Receipt of Phenprocoumon Anticoagulation Therapy}, series = {Point of care : the journal of near-patient testing \& technology}, volume = {19}, journal = {Point of care : the journal of near-patient testing \& technology}, number = {3}, publisher = {Lippincott Williams \& Wilkins}, address = {Philadelphia}, issn = {1533-029X}, doi = {10.1097/POC.0000000000000207}, pages = {72 -- 76}, year = {2020}, abstract = {Background: The LumiraDx INR Test is a new point-of-care diagnostic test designed to analyze fingerstick blood samples. The test was assessed in patients receiving phenprocoumon (NCT04074980). Methods: Venous plasma international normalized ratio (INR) was measured using the LumiraDx INR Test. LumiraDx INR Test-ascertained capillary whole blood INR was compared with venous plasma INR measured using the IL ACL Elite Pro and Sysmex CS-5100 reference instruments. Results: A total of 102 patients receiving phenprocoumon were recruited. The INR results from venous plasma and capillary whole blood that were analyzed on the LumiraDx INR Test correlated well with those measured using the IL ACL Elite Pro (plasma: n = 25, r = 0.981; capillary blood: n = 74, r = 0.949) and the Sysmex CS-5100 (n = 73, r = 0.950). Conclusions: The LumiraDx INR Test showed high accuracy in analyzing venous plasma and capillary whole blood from patients receiving phenprocoumon.}, language = {en} } @article{EichlerSalzwedelHarnathetal.2018, author = {Eichler, Sarah and Salzwedel, Annett and Harnath, Axel and Butter, Christian and Wegscheider, Karl and Chiorean, Mihai and V{\"o}ller, Heinz and Reibis, Rona Katharina}, title = {Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation}, series = {Clinical research in cardiology : official journal of the German Cardiac Society.}, volume = {107}, journal = {Clinical research in cardiology : official journal of the German Cardiac Society.}, number = {4}, publisher = {Springer}, address = {Heidelberg}, issn = {1861-0684}, doi = {10.1007/s00392-017-1183-1}, pages = {304 -- 311}, year = {2018}, abstract = {The aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up. From 10/2013 to 07/2015, 344 patients (80.9 +/- 5.0 years, 44.5\% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model. At discharge, 333 patients were alive (in-hospital mortality 3.2\%; n = 11). During a follow-up of 381.0 +/- 41.9 days, 46 patients (13.8\%) died. The non-survivors were older (82.3 +/- 5.0 vs. 80.6 +/- 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 +/- 1.3 vs. 2.1 +/- 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 +/- 13.6 vs. 54.6 +/- 10.6\%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6\%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72-0.95; p = 0.006) and mobility (OR 5.12, CI 1.64-16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10-4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5\%, CI 1.07-1.36; p = 0.002) were associated with a higher risk of all-cause mortality. Besides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores.}, language = {en} } @article{HadzicEichlerVoelleretal.2022, author = {Hadzic, Miralem and Eichler, Sarah and V{\"o}ller, Heinz and Salzwedel, Annett}, title = {Akzeptanz und Nutzung eines telemedizinischen Rehabilitationsprogramms f{\"u}r Patienten mit Knie- oder H{\"u}ft-Totalendoprothese}, series = {Bewegungstherapie und Gesundheitssport : B \& G ; offizielles Organ des Deutschen Verbandes f{\"u}r Gesundheitssport und Sporttherapie e.V. (DVGS)}, volume = {38}, journal = {Bewegungstherapie und Gesundheitssport : B \& G ; offizielles Organ des Deutschen Verbandes f{\"u}r Gesundheitssport und Sporttherapie e.V. (DVGS)}, number = {01}, publisher = {Thieme}, address = {Stuttgart}, organization = {Arbeitsgrp ReMove-It}, issn = {1613-0863}, doi = {10.1055/a-1714-3629}, pages = {20 -- 25}, year = {2022}, abstract = {Objective of the study: The long-term use of telemedical programs depends not only on their effectiveness, but also on patient acceptance and satisfaction. The effectiveness of telemedical exercise therapy for patients after implantation of a total knee or hip prosthesis and subsequent rehabilitation has already been examined in a randomized controlled study. This article focuses on the patient's acceptance and usage behaviour with regard to the tele-rehabilitation system. Methodology: 48 patients (53 +/- 7 years; 26 women; 35 hip/13 knee TEP) were questioned after a three-month telemedical movement therapy using the Telehealth Usability Questionnaire (TUQ) to determine the acceptance of the technology. The questionnaire consisted of 21 items (seven-point Likert scale) in six scales (e. g. usefulness, quality of interactions, reliability). System-specific questions were summarized on an additional scale. The results were presented as a percentage of the scale (100 estimates complete agreement). The usage behaviour was examined using system-generated process data for training and integrated voice/text messages. Results: The TUQ scales "Usefulness" (Mdn 95.2) and "Ease of use and learnability" (Mdn 92.9) were rated the highest, while "Reliability" (Mdn 57.1) and "Quality of interactions" ( Mdn 71.4) showed the lowest levels. The system-specific scale was placed in the upper quartile (Mdn 85.7). In the first week, 39 patients (81\%) and in the second 45 patients (94\%) performed at least one training exercise with the system. The proportion of active patients (>= 1 exercise/week) decreased in the further course to 75\% (n=36) in the 7th week and 48\% (n=23) in the 12th week. The system communication options were initially used frequently after the start of therapy: in the first week, 42 patients (88\%) sent messages, 47 patients (98\%) received messages from their therapist respectively. In week 7, 9 (19\%) and 13 (27\%) patients sent/received messages via the system respectively. Conclusion: Most of the patients perceived telemedical movement therapy as useful and user-friendly and seemed to be largely satisfied with the system. This proved to be well suited for short-term use of 6 to 8 weeks following subsequent rehabilitation.}, language = {de} } @article{WochatzTilgnerMuelleretal.2019, author = {Wochatz, Monique and Tilgner, Nina and Mueller, Steffen and Rabe, Sophie and Eichler, Sarah and John, Michael and V{\"o}ller, Heinz and Mayer, Frank}, title = {Reliability and validity of the Kinect V2 for the assessment of lower extremity rehabilitation exercises}, series = {Gait \& posture}, volume = {70}, journal = {Gait \& posture}, publisher = {Elsevier}, address = {Clare}, issn = {0966-6362}, doi = {10.1016/j.gaitpost.2019.03.020}, pages = {330 -- 335}, year = {2019}, abstract = {Research question: The purpose of this study was to evaluate the test-retest reliability of lower extremity kinematics during squat, hip abduction and lunge exercises captured by the Kinect and to evaluate the agreement to a reference 3D camera-based motion system. Methods: Twenty-one healthy individuals performed five repetitions of each lower limb exercise on two different days. Movements were simultaneously assessed by the Kinect and the reference 3D motion system. Joint angles and positions of the lower limb were calculated for sagittal and frontal plane. For the inter-session reliability and the agreement between the two systems standard error of measurement (SEM), bias with limits of agreement (LoA) and Pearson Correlation Coefficient (r) were calculated. Results: Parameters indicated varying reliability for the assessed joint angles and positions and decreasing reliability with increasing task complexity. Across all exercises, measurement deviations were shown especially for small movement amplitudes. Variability was acceptable for joint angles and positions during the squat, partially acceptable during the hip abduction and predominately inacceptable during the lunge. The agreement between systems was characterized by systematic errors. Overestimations by the Kinect were apparent for hip flexion during the squat and hip abduction/adduction during the hip abduction exercise as well as for the knee positions during the lunge. Knee and hip flexion during hip abduction and lunge were underestimated by the Kinect. Significance: The Kinect system can reliably assess lower limb joint angles and positions during simple exercises. The validity of the system is however restricted. An application in the field of early orthopedic rehabilitation without further development of post-processing techniques seems so far limited.}, language = {en} } @article{HeidlerSalzwedelJoebgesetal.2018, author = {Heidler, Maria-Dorothea and Salzwedel, Annett and J{\"o}bges, Michael and L{\"u}ck, Olaf and Dohle, Christian and Seifert, Michael and von Helden, Andrea and Hollweg, Wibke and V{\"o}ller, Heinz}, title = {Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals}, series = {BMC Anesthesiology}, volume = {18}, journal = {BMC Anesthesiology}, publisher = {BMC}, address = {London}, issn = {1471-2253}, doi = {10.1186/s12871-018-0527-3}, pages = {7}, year = {2018}, abstract = {Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 +/- 12.9 years, 68\% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge. Results: Four hundred seventy patients (57\%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated. Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic.}, language = {en} } @article{SalzwedelHeidlerHauboldetal.2017, author = {Salzwedel, Annett and Heidler, Maria-Dorothea and Haubold, Kathrin and Schikora, Martin and Reibis, Rona Katharina and Wegscheider, Karl and J{\"o}bgens, Michael and V{\"o}ller, Heinz}, title = {Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation}, series = {Vascular Health and Risk Management}, volume = {13}, journal = {Vascular Health and Risk Management}, publisher = {Dove Medical Press Ltd}, address = {Albany, Auckland}, issn = {1176-6344}, doi = {10.2147/VHRM.S121086}, pages = {55 -- 60}, year = {2017}, abstract = {Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8\% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7\%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7\%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8\%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5\%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95\% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95\% confidence interval 1.42-3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.}, language = {en} } @misc{SalzwedelHeidlerHauboldetal.2016, author = {Salzwedel, Annett and Heidler, Maria-Dorothea and Haubold, Kathrin and Schikora, Martin and Reibis, Rona Katharina and Wegscheider, Karl and J{\"o}bgens, Michael and V{\"o}ller, Heinz}, title = {Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-104113}, pages = {55 -- 60}, year = {2016}, abstract = {Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8\% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7\%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7\%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8\%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5\%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95\% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95\% confidence interval 1.42-3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.}, language = {en} } @article{EichlerSalzwedelRabeetal.2019, author = {Eichler, Sarah and Salzwedel, Annett and Rabe, Sophie and Mueller, Steffen and Mayer, Frank and Wochatz, Monique and Hadzic, Miralem and John, Michael and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement}, series = {JMIR Rehabilitation and Assistive Technologies}, volume = {6}, journal = {JMIR Rehabilitation and Assistive Technologies}, number = {2}, publisher = {jmir rehab}, address = {Toronto}, issn = {2369-2529}, doi = {10.2196/14236}, pages = {12}, year = {2019}, abstract = {Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3\% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75\%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6\%; P=.01) versus the control group (46.2\%) is of note. Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.}, language = {en} } @article{SalzwedelReibisHadzicetal.2019, author = {Salzwedel, Annett and Reibis, Rona Katharina and Hadzic, Miralem and Buhlert, Hermann and V{\"o}ller, Heinz}, title = {Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation}, series = {Vascular Health and Risk Management}, volume = {15}, journal = {Vascular Health and Risk Management}, publisher = {Dove Medical Press}, address = {Albany, Auckland}, issn = {1176-6344}, doi = {10.2147/VHRM.S216039}, pages = {301 -- 308}, year = {2019}, abstract = {Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods: We analyzed routine data of 884 patients (52±7 years, 76\% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, W{\"u}rzburger screening) at admission to CR were considered. Results: A negative occupational prognosis was detected in 384 patients (43\%). Out of these, 368 (96\%) expected not to return to work after CR and/or were unemployed before CR at 29\% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12\% vs 3\%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21\% of this group (n=81) were fit for work (vs 35\% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95\% CI 0.2-0.6, P<0.01), negative occupational expectations (OR 0.4, 95\% CI 0.3-0.7, P<0.01) and depression (OR 0.3, 95\% CI 0.1-0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.}, language = {en} } @misc{SalzwedelHadzicBuhlertetal.2018, author = {Salzwedel, Annett and Hadzic, Miralem and Buhlert, Hermann and V{\"o}ller, Heinz}, title = {Impact of self-assessment of return to work on employable discharge from multi-component cardiac rehabilitation}, series = {European heart journal}, volume = {39}, journal = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {21 -- 22}, year = {2018}, abstract = {Impact of self-assessment of return to work on employable discharge from multi-component cardiac rehabilitation. Retrospective unicentric analysis of routine data from cardiac rehabilitation in patients below 65 years of age. Presentation in the "Cardiovascular rehabilitation revisited" high impact abstract session during ESC Congress 2018.}, language = {en} } @misc{SalzwedelReibisHadzicetal.2019, author = {Salzwedel, Annett and Reibis, Rona Katharina and Hadzic, Miralem and Buhlert, Hermann and V{\"o}ller, Heinz}, title = {Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation}, series = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, number = {574}, issn = {1866-8364}, doi = {10.25932/publishup-43726}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-437263}, pages = {301 -- 308}, year = {2019}, abstract = {Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods: We analyzed routine data of 884 patients (52±7 years, 76\% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, W{\"u}rzburger screening) at admission to CR were considered. Results: A negative occupational prognosis was detected in 384 patients (43\%). Out of these, 368 (96\%) expected not to return to work after CR and/or were unemployed before CR at 29\% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12\% vs 3\%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21\% of this group (n=81) were fit for work (vs 35\% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95\% CI 0.2-0.6, P<0.01), negative occupational expectations (OR 0.4, 95\% CI 0.3-0.7, P<0.01) and depression (OR 0.3, 95\% CI 0.1-0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.}, language = {en} } @misc{ReibisSalzwedelBonaventuraetal.2017, author = {Reibis, Rona Katharina and Salzwedel, Annett and Bonaventura, Klaus and V{\"o}ller, Heinz and Wegscheider, Karl}, title = {Improvement of left ventricular ejection fraction in revascularized postmyocardial patients}, series = {Postprints der Universit{\"a}t Potsdam : Mathematisch Naturwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Mathematisch Naturwissenschaftliche Reihe}, number = {882}, issn = {1866-8372}, doi = {10.25932/publishup-43509}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-435093}, pages = {10}, year = {2017}, abstract = {BACKGROUND: Reduced left ventricular ejection fraction (LVEF) ≤30\% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD). METHODS: We performed a retrospective analysis of 277 patients with reduced LVEF at least 1month after MI and complete revascularization. Patients (median time post-MI 23.4months; 74.3\% after PCI, 25.7\% after CABG were assigned either to group 1 (LVEF<30\%) or group 2 (LVEF 30-40\%). Biplane echocardiography was redone after a mean follow-up of 441±220days. RESULTS: LVEF increased significantly in both two groups (group 1: 26.2±4.8\% to 32.4±8.5\%; p<0.001; group 2: 38.2±2.5\% to 44.4±9.6\%; p<0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37\% (p<0.001) with a large interindividual variation. CONCLUSIONS: The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.}, language = {en} } @article{SalzwedelJensenRauchetal.2020, author = {Salzwedel, Annett and Jensen, Katrin and Rauch, Bernhard and Doherty, Patrick and Metzendorf, Maria-Inti and Hackbusch, Matthes and V{\"o}ller, Heinz and Schmid, Jean-Paul and Davos, Constantinos H.}, title = {Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {27}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {16}, publisher = {Oxford Univ. Press}, address = {Oxford}, organization = {Univ Heidelberg Heinrich Heine Univ}, issn = {2047-4873}, doi = {10.1177/2047487320905719}, pages = {1756 -- 1774}, year = {2020}, abstract = {Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Resulte Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95\% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95\% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95\% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95\% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95\% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.}, language = {en} } @misc{MainkaWisselVoelleretal.2018, author = {Mainka, Stefan and Wissel, J{\"o}rg and V{\"o}ller, Heinz and Evers, Stefan}, title = {The use of rhythmic auditory stimulation to optimize treadmill training for stroke patients}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {655}, issn = {1866-8364}, doi = {10.25932/publishup-45917}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-459179}, pages = {10}, year = {2018}, abstract = {The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SR The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 +/- 8.6 years, mean time between stroke and start of study 42.1 +/- 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F-(2,F- (34)) = 3.864, p = 0.032; partial eta(2) = 0.205] and cadence [F-(2,F- 34) = 7.656, p = 0.002; partial eta(2) = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.}, language = {en} } @misc{SalzwedelKoranLangheimetal.2020, author = {Salzwedel, Annett and Koran, Iryna and Langheim, Eike and Schlitt, Axel and Nothroff, J{\"o}rg and Bongarth, Christa and Wrenger, Markus and Sehner, Susanne and Reibis, Rona Katharina and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Patient-reported outcomes predict return to work and health-related quality of life six months after cardiac rehabilitation}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {910}, issn = {1866-8364}, doi = {10.25932/publishup-46983}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-469839}, pages = {19}, year = {2020}, abstract = {Background Multi-component cardiac rehabilitation (CR) is performed to achieve an improved prognosis, superior health-related quality of life (HRQL) and occupational resumption through the management of cardiovascular risk factors, as well as improvement of physical performance and patients' subjective health. Out of a multitude of variables gathered at CR admission and discharge, we aimed to identify predictors of returning to work (RTW) and HRQL 6 months after CR. Design Prospective observational multi-centre study, enrolment in CR between 05/2017 and 05/2018. Method Besides general data (e.g. age, sex, diagnoses), parameters of risk factor management (e.g. smoking, hypertension), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance) and patient-reported outcome measures (e.g. depression, anxiety, HRQL, subjective well-being, somatic and mental health, pain, lifestyle change motivation, general self-efficacy, pension desire and self-assessment of the occupational prognosis using several questionnaires) were documented at CR admission and discharge. These variables (at both measurement times and as changes during CR) were analysed using multiple linear regression models regarding their predictive value for RTW status and HRQL (SF-12) six months after CR. Results Out of 1262 patients (54±7 years, 77\% men), 864 patients (69\%) returned to work. Predictors of failed RTW were primarily the desire to receive pension (OR = 0.33, 95\% CI: 0.22-0.50) and negative self-assessed occupational prognosis (OR = 0.34, 95\% CI: 0.24-0.48) at CR discharge, acute coronary syndrome (OR = 0.64, 95\% CI: 0.47-0.88) and comorbid heart failure (OR = 0.51, 95\% CI: 0.30-0.87). High educational level, stress at work and physical and mental HRQL were associated with successful RTW. HRQL was determined predominantly by patient-reported outcome measures (e.g. pension desire, self-assessed health prognosis, anxiety, physical/mental HRQL/health, stress, well-being and self-efficacy) rather than by clinical parameters or physical performance. Conclusion Patient-reported outcome measures predominantly influenced return to work and HRQL in patients with heart disease. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption.}, language = {en} } @misc{ZochLesniakDobberkeSchlittetal.2020, author = {Zoch-Lesniak, Beate and Dobberke, Jeanette and Schlitt, Axel and Bongarth, Christa and Glatz, Johannes and Sp{\"o}rl-D{\"o}nch, Sieglinde and Koran, Iryna and V{\"o}ller, Heinz and Salzwedel, Annett}, title = {Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age}, series = {Postprints der Universit{\"a}t Potsdam : Mathematisch-Naturwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Mathematisch-Naturwissenschaftliche Reihe}, issn = {1866-8364}, doi = {10.25932/publishup-47392}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-473922}, pages = {16}, year = {2020}, abstract = {Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting: Comprehensive 3-week CR.}, language = {en} } @misc{EichlerVoellerReibisetal.2020, author = {Eichler, Sarah and V{\"o}ller, Heinz and Reibis, Rona Katharina and Wegscheider, Karl and Butter, Christian and Harnath, Axel and Salzwedel, Annett}, title = {Geriatric or cardiac rehabilitation?}, series = {Postprints der Universit{\"a}t Potsdam : Mathematisch-Naturwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Mathematisch-Naturwissenschaftliche Reihe}, issn = {1866-8364}, doi = {10.25932/publishup-47395}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-473958}, pages = {11}, year = {2020}, abstract = {Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0\% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.}, language = {en} } @misc{EichlerSalzwedelRabeetal.2019, author = {Eichler, Sarah and Salzwedel, Annett and Rabe, Sophie and Mueller, Steffen and Mayer, Frank and Wochatz, Monique and Hadzic, Miralem and John, Michael and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {589}, issn = {1866-8364}, doi = {10.25932/publishup-44096}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-440965}, pages = {14}, year = {2019}, abstract = {Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3\% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75\%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6\%; P=.01) versus the control group (46.2\%) is of note. Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.}, language = {en} } @article{SchulzBehrendtSalzwedelRabeetal.2017, author = {Schulz-Behrendt, Claudia and Salzwedel, Annett and Rabe, Sophie and Ortmann, K. and V{\"o}ller, Heinz}, title = {Aspekte beruflicher und sozialer Wiedereingliederung aus Sicht kardiovaskul{\"a}r erkrankter Rehabilitanden in besonderen beruflichen Problemlagen}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {56}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {3}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0042-121379}, pages = {181 -- 188}, year = {2017}, abstract = {Ziel: Untersucht wurden subjektive bio-psycho-soziale Auswirkungen chronischer Herz- und Gef{\"a}ßerkrankungen, Bew{\"a}ltigungsstrategien und Formen sozialer Unterst{\"u}tzung bei Rehabilitanden in besonderen beruflichen Problemlagen (BBPL). Methodik: F{\"u}r die qualitative Untersuchung wurden 17 Patienten (48,9±7,0 Jahre, 13 m{\"a}nnl.) mit BBPL (SIMBO-C>30) in leitfadengest{\"u}tzten Interviews befragt. Die Auswertung erfolgte softwaregest{\"u}tzt nach dem inhaltsanalytischen Ansatz von Mayring. Ergebnisse: Im Rahmen der Krankheitsauswirkungen benannten die Patienten soziale, einschließlich beruflicher Aspekte mit 62\% der Aussagen deutlich h{\"a}ufiger als physische oder psychische Faktoren (9 bzw. 29\%). Angewandte Bew{\"a}ltigungsstrategien und erfahrene Unterst{\"u}tzungsleistungen richteten sich jedoch {\"u}berwiegend auf k{\"o}rperliche Einschr{\"a}nkungen (70 bzw. 45\%). Schlussfolgerung: Obgleich soziale Krankheitsauswirkungen f{\"u}r die befragten Rehabilitanden subjektiv bedeutsam waren, gelang die Entwicklung geeigneter Bew{\"a}ltigungsstrategien nur unzureichen}, language = {de} } @misc{VoellerBindlNagelsetal.2017, author = {V{\"o}ller, Heinz and Bindl, Dominik and Nagels, Klaus and Hofmann, Reiner and Vettorazzi, Eik and Wegscheider, Karl and Fleck, Eckart and Nagel, Eckhard}, title = {Remote telemonitoring in chronic heart failure does not reduce healthcare cost but improves quality of life}, series = {Journal of the American College of Cardiology}, volume = {69}, journal = {Journal of the American College of Cardiology}, number = {11 Supplement}, publisher = {Elsevier}, address = {New York}, issn = {0735-1097}, pages = {672 -- 672}, year = {2017}, abstract = {Background: Evidence that home telemonitoring (HTM) for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Therefore the CardioBBEAT trial was designed to prospectively assess the health economic impact of a dedicated home monitoring system for patients with CHF based on actual costs directly obtained from patients' health care providers. Methods: Between January 2010 and June 2013, 621 patients (mean age 63,0 ± 11,5 years, 88 \% male) with a confirmed diagnosis of CHF (LVEF ≤ 40 \%) were enrolled and randomly assigned to two study groups comprising usual care with and without an interactive bi-directional HTM (Motiva®). The primary endpoint was the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow up of 12 months. Secondary outcome measures were total mortality and health related quality of life (SF-36, WHO-5 and KCCQ). Results: In the intention-to-treat analysis, total mortality (HR 0.81; 95\% CI 0.45 - 1.45) and days alive and not in hospital (343.3 ± 55.4 vs. 347.2 ± 43.9; p = 0.909) were not significantly different between HTM and usual care. While the resulting primary endpoint ICER was not positive (-181.9; 95\% CI -1626.2 ± 1628.9), quality of life assessed by SF-36, WHO-5 and KCCQ as a secondary endpoint was significantly higher in the HTW group at 6 and 12 months of follow-up. Conclusions: The first simultaneous assessment of clinical and economic outcome of HTM in patients with CHF did not demonstrate superior incremental cost effectiveness compared to usual care. On the other hand, quality of life was improved. It remains open whether the tested HTM solution represents a useful innovative approach in the recent health care setting.}, language = {en} } @article{ReibisSalzwedelFalketal.2017, author = {Reibis, Rona Katharina and Salzwedel, Annett and Falk, Johannes and V{\"o}ller, Heinz}, title = {Berufliche Wiedereingliederung nach akutem Herzinfarkt}, series = {Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft f{\"u}r Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und {\"A}rzte (GDN{\"A})}, volume = {142}, journal = {Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft f{\"u}r Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und {\"A}rzte (GDN{\"A})}, publisher = {Thieme}, address = {Stuttgart}, issn = {0012-0472}, doi = {10.1055/s-0042-124425}, pages = {617 -- 624}, year = {2017}, abstract = {Die berufliche Wiedereingliederung von Patienten nach akutem Herzinfarkt stellt sowohl aus gesellschaftlicher wie auch aus individueller Sicht einen entscheidenden Schritt zur vollst{\"a}ndigen Rekonvaleszenz dar. Lediglich 10\% der Patienten werden durch kardiale Probleme an der Reintegration behindert. Neben medizinischen und berufsbezogenen Faktoren determinieren insbesondere psychosoziale Parameter eine erfolgreiche Wiederaufnahme der T{\"a}tigkeit. Verschiedene Programme der Rentenversicherungstr{\"a}ger werden dabei unterst{\"u}tzend angeboten.}, language = {de} } @article{EichlerSalzwedelReibisetal.2017, author = {Eichler, Sarah and Salzwedel, Annett and Reibis, Rona and Nothroff, J{\"o}rg and Harnath, Axel and Schikora, Martin and Butter, Christian and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Multicomponent cardiac rehabilitation 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 = {24}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {3}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487316679527}, pages = {257 -- 264}, year = {2017}, abstract = {Background: In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods: From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results: One hundred and thirty-six patients (80.6 +/- 5.0 years, 47.8\% male) were enrolled. 6MWD and maximum work load increased by 56.3 +/- 65.3 m (p < 0.001) and 8.0 +/- 14.9 watts (p < 0.001), respectively. An improvement in SF-12 (physical 2.5 +/- 8.7, p = 0.001, mental 3.4 +/- 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions: Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.}, language = {en} } @misc{HansenNiebauerCornelissenetal.2018, author = {Hansen, Dominique and Niebauer, Josef and Cornelissen, Veronique and Barna, Olga and Neunhaeuserer, Daniel and Stettler, Christoph and Tonoli, Cajsa and Greco, Eugenio and Fagard, Robert and Coninx, Karin and Vanhees, Luc and Piepoli, Massimo F. and Pedretti, Roberto and Ruiz, Gustavo Rovelo and Corra, Ugo and Schmid, Jean-Paul and Davos, Constantinos H. and Edelmann, Frank and Abreu, Ana and Rauch, Bernhard and Ambrosetti, Marco and Braga, Simona Sarzi and Beckers, Paul and Bussotti, Maurizio and Faggiano, Pompilio and Garcia-Porrero, Esteban and Kouidi, Evangelia and Lamotte, Michel and Reibis, Rona Katharina and Spruit, Martijn A. and Takken, Tim and Vigorito, Carlo and V{\"o}ller, Heinz and Doherty, Patrick and Dendale, Paul}, title = {Exercise prescription in patients with different combinations of cardiovascular disease risk factors}, series = {Sports medicine}, volume = {48}, journal = {Sports medicine}, number = {8}, publisher = {Springer}, address = {Northcote}, issn = {0112-1642}, doi = {10.1007/s40279-018-0930-4}, pages = {1781 -- 1797}, year = {2018}, abstract = {Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice \& Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.}, language = {en} } @article{SalzwedelRabeZahnetal.2018, author = {Salzwedel, Annett and Rabe, Sophie and Zahn, Thomas and Neuwirth, Julia and Eichler, Sarah and Haubold, Kathrin and Wachholz, Anne and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {Nutzerinteresse an mobilen digitalen Assistenzsystemen zur F{\"o}rderung k{\"o}rperlicher Aktivit{\"a}t bei Studierenden und Mitarbeitern einer Universit{\"a}t}, series = {Gesundheitswesen}, volume = {80}, journal = {Gesundheitswesen}, number = {11}, publisher = {Thieme}, address = {Stuttgart}, issn = {0941-3790}, doi = {10.1055/s-0043-103951}, pages = {1023 -- 1025}, year = {2018}, abstract = {Hintergrund Einem Großteil der Bev{\"o}lkerung gelingt es trotz ausreichenden Wissens um die protektiven Effekte nicht, ausreichende k{\"o}rperliche Aktivit{\"a}t in den Alltag zu integrieren. Digitale Assistenzsysteme k{\"o}nnten hierbei unterst{\"u}tzend eingesetzt werden. Dies setzt jedoch das Interesse potentieller Nutzer voraus. Methode In einer Online-Befragung wurden im Juni/Juli 2015 Mitarbeiter und Studierende der Universit{\"a}t Potsdam zum individuellen Ausmaß der sportlichen Aktivit{\"a}t, dem Interesse an elektronischer Trainingsunterst{\"u}tzung und weiteren Parametern befragt. Ergebnis 1217 Studierende und 485 Mitarbeiter (67,3 bzw. 67,5\% Frauen, 26±4,9 bzw. 42,7±11,7 Jahre) nahmen an der Studie teil. Die empfohlene sportliche Aktivit{\"a}t (≥3 Tage bzw. 150 min/Woche) wurde von 70,1\% der Mitarbeiter und 52,7\% der Studierenden nicht erreicht. Innerhalb dieser Gruppen zeigten 53,2\% (Studierende) bzw. 44,2\% (Mitarbeiter), unabh{\"a}ngig von Alter, Geschlecht, BMI bzw. Bildungsniveau, Interesse an einer elektronischen Trainingsunterst{\"u}tzung. Schlussfolgerung Auch in j{\"u}ngeren Bev{\"o}lkerungsgruppen mit hohem Bildungsniveau ist die Mehrzahl der Personen unzureichend k{\"o}rperlich aktiv. Ein Interesse an Trainingsunterst{\"u}tzung besteht in etwa der H{\"a}lfte dieser sportlich inaktiven Gruppe. Dies legt den Schluss nahe, dass der personalisierte Einsatz mobiler Assistenzsysteme f{\"u}r die positive Beeinflussung des Lebensstils zunehmend an Bedeutung gewinnen k{\"o}nnte.}, language = {de} } @article{KieferVoellerNothroffetal.2019, author = {Kiefer, Thomas and V{\"o}ller, Heinz and Nothroff, J{\"o}rg and Schikora, Martin and von Podewils, Sebastian and Sicher, Claudia and Bartels-Reinisch, Birgit and Heyne, Karolin and Haase, Hermann and J{\"u}nger, Michael and Daeschlein, Georg}, title = {Multiresistente Erreger in der onkologischen und kardiologischen Rehabilitation}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {58}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {2}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/a-0638-9226}, pages = {136 -- 142}, year = {2019}, abstract = {In der vorliegenden Studie wurde die Pr{\"a}valenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5\% der onkologischen und 4,5\% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am h{\"a}ufigsten wurden 2-MRGN und ESBL (2,9\%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Pr{\"a}valenzraten f{\"u}r 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3\%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Pr{\"a}valenzraten f{\"u}r multiresistente Krankenhauskeime.}, language = {de} } @article{BoujemaaYilmazRobicetal.2019, author = {Boujemaa, Hajar and Yilmaz, Alaaddin and Robic, Boris and Koppo, Katrien and Claessen, Guido and Frederix, Ines and Dendale, Paul and V{\"o}ller, Heinz and van Loon, Luc J. C. and Hansen, Dominique}, title = {The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function}, series = {Experimental physiology}, volume = {104}, journal = {Experimental physiology}, number = {6}, publisher = {Wiley}, address = {Hoboken}, issn = {0958-0670}, doi = {10.1113/EP087407}, pages = {855 -- 865}, year = {2019}, abstract = {Suboptimal post-operative improvements in functional capacity are often observed after minimally invasive aortic valve replacement (mini-AVR). It remains to be studied how AVR affects the cardiopulmonary and skeletal muscle function during exercise to explain these clinical observations and to provide a basis for improved/tailored post-operative rehabilitation. Twenty two patients with severe aortic stenosis (AS) (aortic valve area (AVA) < 1.0 cm(2)) were preoperatively compared to 22 healthy controls during submaximal constant-workload endurance-type exercise for oxygen uptake (V-O2), carbon dioxide output (V-CO2), respiratory gas exchange ratio, expiratory volume (V-E), ventilatory equivalents for O-2 (V-E/V-O2) and CO2 (V-E/V-CO2), respiratory rate (RR), tidal volume (V-t), heart rate (HR), oxygen pulse (V-O2/HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise-onset V-O2 kinetics. These exercise tests were repeated at 5 and 21 days after AVR surgery (n = 14), along with echocardiographic examinations. Respiratory exchange ratio and ventilatory equivalents (V-E/V-O2 and V-E/V-CO2) were significantly elevated, V-O2 and V-O2/HR were significantly lowered, and exercise-onset V-O2 kinetics were significantly slower in AS patients vs. healthy controls (P < 0.05). Although the AVA was restored by mini-AVR in AS patients, V-E/V-O2 and V-E/V-CO2 further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE, V-E and RR, and lowered V-t. At 21 days after mini-AVR, exercise-onset V-O2 kinetics further slowed significantly (P < 0.05). A decline in pulmonary function was observed early aftermini-AVRsurgery, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. Therefore, a tailored rehabilitation programmeshould include training modalities for the respiratory and peripheral muscular system.}, language = {en} } @article{HansenKraenkelKempsetal.2019, author = {Hansen, Dominique and Kraenkel, Nicolle and Kemps, Hareld and Wilhelm, Matthias and Abreu, Ana and Pfeiffer, Andreas F. H. and Jordao, Alda and Cornelissen, Veronique and V{\"o}ller, Heinz}, title = {Management of patients with type 2 diabetes in cardiovascular rehabilitation}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {26}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {2_SUPPL}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487319882820}, pages = {133 -- 144}, year = {2019}, abstract = {The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy.}, language = {en} } @article{SalzwedelWegscheiderSchulzBehrendtetal.2019, author = {Salzwedel, Annett and Wegscheider, Karl and Schulz-Behrendt, Claudia and D{\"o}rr, Gesine and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {No impact of an extensive social intervention program on return to work and quality of life after acute cardiac event: a cluster-randomized trial in patients with negative occupational prognosis}, series = {International archives of occupational and environmental health}, volume = {92}, journal = {International archives of occupational and environmental health}, number = {8}, publisher = {Springer}, address = {New York}, issn = {0340-0131}, doi = {10.1007/s00420-019-01450-3}, pages = {1109 -- 1120}, year = {2019}, abstract = {Objectives To examine the effectiveness of extensive social therapy intervention during inpatient multi-component cardiac rehabilitation (CR) on return to work and quality of life in patients with low probability of work resumption after an acute cardiac event. Methods Patients after acute cardiac event with negative subjective expectations about return to work or unemployment (n = 354) were included and randomized in clusters of 3-6 study participants. Clusters were randomized for social counseling and therapy led by a social worker, six sessions of 60 min each in 3 weeks, or control group (usual care: individual counseling meeting by request). The return to work (RTW) status and change in quality of life (QoL, short form 12: Physical and Mental Component Summary PCS and MCS) 12 months after discharge from inpatient CR were outcome measures. Results The regression model for RTW showed no impact of the intervention (OR 1.1, 95\% CI 0.6-2.1, P = 0.79; n = 263). Predictors were unemployment prior to CR as well as higher anxiety values at discharge from CR. Likewise, QoL was not improved by social therapy (linear mixed model: Delta PCS 0.3, 95\% CI - 1.9 to 2.5; P = 0.77; n = 177; Delta MCS 0.7, 95\% CI - 1.9 to 3.3; P = 0.58; n = 215). Conclusions In comparison to usual care, an intensive program of social support for patients during inpatient cardiac rehabilitation after an acute cardiac event had no additional impact on either the rate of resuming work or quality of life.}, language = {en} } @article{KieferKrahlOsthoffetal.2017, author = {Kiefer, Thomas and Krahl, Dorothea and Osthoff, Kathrin and Thuss-Patience, Peter and Bunse, J{\"o}rg and Adam, Ulrich and Jansen, Marc H. and Ott, Rudolf and Pfitzmann, Robert and Pross, Matthias and Kohlmann, Thomas and Daeschlein, Georg and Buhlert, Hermann and V{\"o}ller, Heinz and Hirt, Carsten}, title = {Importance of Pancreatic Enzyme Replacement Therapy after Surgery of Cancer of the Esophagus or the Esophagogastric Junction}, series = {Nutrition and cancer : an international journal}, volume = {70}, journal = {Nutrition and cancer : an international journal}, number = {1}, publisher = {Routledge, Taylor \& Francis Group}, address = {Abingdon}, issn = {0163-5581}, doi = {10.1080/01635581.2017.1374419}, pages = {69 -- 72}, year = {2017}, abstract = {After surgical treatment of cancer of the esophagus or the esophagogastric junction we observed steatorrhea, which is so far seldom reported. We analyzed all patients treated in our rehabilitation clinic between 2011 and 2014 and focused on the impact of surgery on digestion of fat. Reported steatorrhea was anamnestic, no pancreatic function test was made. Here we show the results from 51 patients. Twenty-three (45\%) of the patients reported steatorrhea. Assuming decreased pancreatic function pancreatic enzyme replacement therapy (PERT) was started or modified during the rehabilitation stay (in the following called STEA(+)). These patients were compared with the patients without steatorrhea and without PERT (STEA(-)). Maximum weight loss between surgery and rehabilitation start was 18 kg in STEA(+) patient and 15.3 kg in STEA(-) patients. STEA(+) patients gained more weight under PERT during the rehabilitation phase (3 wk) than STEA(-) patients without PERT (+1.0 kg vs. -0.3 kg, P = 0.032). We report for the first time, that patients after cancer related esophageal surgery show anamnestic signs of exocrine pancreas insufficiency and need PERT to gain body weight.}, language = {en} } @article{BaritelloSalzwedelSuendermannetal.2021, author = {Baritello, Omar and Salzwedel, Annett and S{\"u}ndermann, Simon and Niebauer, Josef and V{\"o}ller, Heinz}, title = {The Pandora's Box of frailty assessments: Which is the best for clinical purposes in TAVI patients? A critical review}, series = {Journal of Clinical Medicine}, volume = {10}, journal = {Journal of Clinical Medicine}, edition = {19}, publisher = {MDPI}, address = {Basel, Schweiz}, issn = {2077-0383}, doi = {10.3390/jcm10194506}, pages = {1 -- 17}, year = {2021}, abstract = {Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95\% confidence interval (CI) 6.50-33.30) and lower serum albumin level (highest HR: 3.12; 95\% CI 1.80-5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95\% CI 2.71-86.10) and 1-year mortality (highest OR: 2.75; 95\% CI 1.55-4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty. View Full-Text}, language = {en} } @article{HeidlerBiduVoelleretal.2017, author = {Heidler, Maria-Dorothea and Bidu, Laura and V{\"o}ller, Heinz and Salzwedel, Annett}, title = {Pr{\"a}diktoren des kognitiven Outcomes beatmeter Fr{\"u}hrehabilitationspatienten}, series = {Der Nervenarzt : Organ der Deutschen Gesellschaft f{\"u}r Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft f{\"u}r Neurologie}, volume = {88}, journal = {Der Nervenarzt : Organ der Deutschen Gesellschaft f{\"u}r Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft f{\"u}r Neurologie}, publisher = {Springer}, address = {New York}, issn = {0028-2804}, doi = {10.1007/s00115-017-0311-5}, pages = {905 -- 910}, year = {2017}, abstract = {Hintergrund Patienten, die nach gescheitertem Weaning von der Intensivstation in die Fr{\"u}hrehabilitation (FR) verlegt werden, weisen neben motorischen Einschr{\"a}nkungen oft auch Defizite in ihrer kognitiven Leistungsf{\"a}higkeit auf. Welche patientenseitigen Faktoren das kognitive Outcome am Ende der FR beeinflussen, ist noch unzureichend untersucht. Zielstellung Ermittlung von Pr{\"a}diktoren auf das kognitive Leistungsverm{\"o}gen initial beatmeter FR-Patienten. Methode Zwischen 01/2014 und 12/2015 wurden 301 Patienten (68,3 ± 11,4 Jahre, 67 \% m{\"a}nnlich) einer neurologischen Phase-B-Weaningstation konsekutiv in eine prospektive Beobachtungsstudie eingeschlossen. Zur Ermittlung m{\"o}glicher Einflussfaktoren auf das kognitive Outcome (operationalisiert mittels Neuromentalindex [NMI]) wurden soziodemografische Daten, kritische Erkrankung, Komorbidit{\"a}ten, Parameter zu Weaning und Dekan{\"u}lierung sowie diverse Scores zur Ermittlung funktionaler Parameter erhoben und mittels ANCOVA multivariat ausgewertet. Ergebnisse Insgesamt 248 Patienten (82 \%) konnten erfolgreich geweant werden, 155 (52 \%) dekan{\"u}liert, 75 Patienten (25 \%) verstarben, davon 39 (13 \%) unter Palliativtherapie. F{\"u}r die {\"u}berlebenden Patienten (n = 226) konnten im finalen geschlechts- und altersadjustierten statistischen Modell unabh{\"a}ngige Pr{\"a}diktoren des NMI bei Entlassung aus der FR ermittelt werden: Wachheit und erfolgreiche Dekan{\"u}lierung waren positiv mit dem NMI assoziiert, w{\"a}hrend als kritische Erkrankungen hypoxische Hirnsch{\"a}digungen, Hirninfarkte und Sch{\"a}del-Hirn-Traumata einen negativen Einfluss auf die kognitive Leistungsf{\"a}higkeit hatten. Das berechnete Modell begr{\"u}ndet 57 \% der Varianz des NMI (R2 = 0,568) und weist damit eine hohe Erkl{\"a}rungsqualit{\"a}t auf. Schlussfolgerung Aufgrund des erh{\"o}hten Risikos f{\"u}r eine verminderte kognitive Leistungsf{\"a}higkeit zum Ende der FR sollten vor allem Patienten nach Hypoxie, Hirninfarkt und Sch{\"a}del-Hirn-Trauma intensiv neuropsychologisch betreut werden. Da weiterhin eine erfolgreiche Dekan{\"u}lierung mit verbesserten kognitiven Leistungen assoziiert ist, sollte - vor allem bei wachen Patienten - zudem ein z{\"u}giges Trachealkan{\"u}lenmanagement im therapeutischen Fokus stehen.}, language = {de} } @misc{KieferTrendelenburgVoellerNothroffetal.2017, author = {Kiefer-Trendelenburg, Thomas Hermann and V{\"o}ller, Heinz and Nothroff, J{\"o}rg and Schikora, Martin and Bartels-Reinisch, Birgit and Heyne, Karolin and Daeschlein, Georg}, title = {Prevalence of patients with multiresistant pathogens (MRP) in rehabilitation clinics}, series = {Oncology Research and Treatment}, volume = {40}, journal = {Oncology Research and Treatment}, publisher = {Karger}, address = {Basel}, issn = {2296-5270}, pages = {198 -- 198}, year = {2017}, language = {en} } @article{SalzwedelHauboldBarnacketal.2018, author = {Salzwedel, Annett and Haubold, Kathrin and Barnack, Beate and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {Indikatoren der Ergebnisqualit{\"a}t kardiologischer Rehabilitation Ergebnisse einer Delphi-Befragung von Mitgliedern der Deutschen Gesellschaft f{\"u}r Pr{\"a}vention und Rehabilitation von Herz- und Kreislauferkrankungen e. V. (DGPR)}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {58}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {1}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0044-101048}, pages = {31 -- 38}, year = {2018}, abstract = {Ziel der Studie Die vorliegende Untersuchung beinhaltete die explorative Erfassung potenzieller Indikatoren der Ergebnisqualit{\"a}t der kardiologischen Rehabilitation (CR) f{\"u}r Patienten unter 65 Jahren. Methoden In einer 4-stufigen webbasierten Delphi-Befragung (04-07/2016) von in der CR t{\"a}tigen {\"A}rzten[2] , Psychologen und Sport-/Physiotherapeuten wurden Parameter der k{\"o}rperlichen Leistungsf{\"a}higkeit, der Sozialmedizin, der subjektiven Gesundheit und kardiovaskul{\"a}re Risikofaktoren hinsichtlich ihrer Eignung als Qualit{\"a}tsindikator bewertet. Ergebnisse Von 44 vorgegebenen wie auch von den Teilnehmern vorgeschlagenen Parametern wurden 21 Parameter (48\%), die H{\"a}lfte davon psychosoziale Faktoren, als potenzielle Qualit{\"a}tsindikatoren ausgew{\"a}hlt, wobei lediglich f{\"u}r das Rauchverhalten, den Blutdruck, das LDL-Cholesterin und die max. Belastbarkeit im Belastungs-EKG ein Konsens (Zustimmung>75\% der Befragten) erzielt wurde. Schlussfolgerung Die Wahl der Qualit{\"a}tsindikatoren durch die Experten erfolgte mehrheitlich mit nur geringer Einigkeit. Eine klinische und wissenschaftliche Evaluierung der gew{\"a}hlten Parameter ist daher zwingend erforderlich.}, language = {de} } @article{ZochLesniakDobberkeSchlittetal.2020, author = {Zoch-Lesniak, Beate and Dobberke, Jeanette and Schlitt, Axel and Bongarth, Christa and Glatz, Johannes and Sp{\"o}rl-D{\"o}nch, Sieglinde and Koran, Iryna and V{\"o}ller, Heinz and Salzwedel, Annett}, title = {Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age}, series = {Archives of Rehabilitation Research and Clinical Translation}, volume = {2}, journal = {Archives of Rehabilitation Research and Clinical Translation}, publisher = {Elsevier}, address = {Amsterdam}, issn = {2590-1095}, doi = {10.1016/j.arrct.2020.100043}, pages = {14}, year = {2020}, abstract = {Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting: Comprehensive 3-week CR.}, language = {en} } @article{EichlerVoellerReibisetal.2020, author = {Eichler, Sarah and V{\"o}ller, Heinz and Reibis, Rona Katharina and Wegscheider, Karl and Butter, Christian and Harnath, Axel and Salzwedel, Annett}, title = {Geriatric or cardiac rehabilitation?}, series = {BMC Cardiovascular Disorders}, volume = {20}, journal = {BMC Cardiovascular Disorders}, publisher = {BioMed Central}, address = {London}, issn = {1471-2261}, doi = {10.1186/s12872-020-01452-x}, pages = {9}, year = {2020}, abstract = {Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0\% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.}, language = {en} } @article{HauptWolschkeRabeetal.2017, author = {Haupt, T. and Wolschke, M. and Rabe, Sophie and Scholz, I. and Smurawski, A. and Salzwedel, Annett and Thomas, F. and Reich, H. and V{\"o}ller, Heinz and Liebach, J. and Eichler, Sarah}, title = {ReMove-It - Entwicklung einer telemedizinisch assistierten Bewegungstherapie f{\"u}r die Rehabilitation nach Intervention an der unteren Extremit{\"a}t}, series = {B\&G Bewegungstherapie und Gesundheitssport}, volume = {33}, journal = {B\&G Bewegungstherapie und Gesundheitssport}, number = {5}, publisher = {Thieme}, address = {Stuttgart}, issn = {1613-0863}, doi = {10.1055/s-0043-118139}, pages = {221 -- 226}, year = {2017}, abstract = {Knie- und H{\"u}ftgelenksarthrose z{\"a}hlen zu den zehn h{\"a}ufigsten Einzeldiagnosen in orthop{\"a}dischen Praxen. Die Wirksamkeit einer station{\"a}ren Rehabilitation f{\"u}r Patienten nach Knie- oder H{\"u}ft-Totalendoprothese (TEP) ist in mehreren Studien belegt. Dennoch stellt die mittel- und langfristige Nachhaltigkeit zum Erhalt des Therapieerfolges eine große Herausforderung dar. Das Ziel des Projekts ReMove-It ist es, einen Wirksamkeitsnachweis f{\"u}r eintelemedizinisch assistiertes Interventionstraining f{\"u}r Patienten nach einem operativen Eingriff an den unteren Extremit{\"a}ten zu erbringen. In dem Beitrag wird anhand von Erfahrungsberichten dargestellt, wie das interaktive {\"U}bungsprogramm f{\"u}r Knie- und H{\"u}ft-TEP-Patienten entwickelt und das telemedizinische Assistenzsystem MeineReha® in den Behandlungsalltag von drei Rehakliniken integriert wurde. Ebenso werden der Aufbau und Ablauf der klinischen Studie dargestellt und das System aus Sicht der beteiligten {\"A}rzte, und Therapeuten bewertet.}, language = {de} } @article{DobberkeBaritelloHadzicetal.2022, author = {Dobberke, Jeanette and Baritello, Omar and Hadzic, Miralem and V{\"o}ller, Heinz and Eichler, Sarah and Salzwedel, Annett}, title = {Test-retest reliability of center of pressure measures for postural control assessment in older cardiac patients}, series = {Gait \& posture : official journal of Gait and Clinical Movement Analysis Society (GCMAS) and European Society of Movement Analysis in Adults and Children (ESMAC)}, volume = {92}, journal = {Gait \& posture : official journal of Gait and Clinical Movement Analysis Society (GCMAS) and European Society of Movement Analysis in Adults and Children (ESMAC)}, publisher = {Elsevier Science}, address = {Amsterdam}, issn = {0966-6362}, doi = {10.1016/j.gaitpost.2021.12.011}, pages = {359 -- 363}, year = {2022}, abstract = {Background Elderly patients are a growing population in cardiac rehabilitation (CR). As postural control declines with age, assessment of impaired balance is important in older CR patients in order to predict fall risk and to initiate counteracting steps. Functional balance tests are subjective and lack adequate sensitivity to small differences, and are further subject to ceiling effects. A quantitative approach to measure postural control on a continuous scale is therefore desirable. Force plates are already used for this purpose in other clinical contexts, therefore could be a promising tool also for older CR patients. However, in this population the reliability of the assessment is not fully known. Research question Analysis of test-retest reliability of center of pressure (CoP) measures for the assessment of postural control using a force plate in older CR patients. Methods 156 CR patients (> 75 years) were enrolled. CoP measures (path length (PL), mean velocity (MV), and 95\% confidence ellipse area (95CEA)) were analyzed twice with an interval of two days in between (bipedal narrow stance, eyes open (EO) and closed (EC), three trials for each condition, 30 s per trial), using a force plate. For test-retest reliability estimation absolute differences (\& UDelta;: T0-T1), intraclass correlation coefficients (ICC) with 95\% confidence intervals, standard error of measurement and minimal detectable change were calculated. Results Under EO condition ICC were excellent for PL and MV (0.95) and good for 95CEA (0.88) with \& UDelta; of 10.1 cm (PL), 0.3 cm/sec (MV) and 1.5 cm(2 )(95CEA) respectively. Under EC condition ICC were excellent (> 0.95) for all variables with larger \& UDelta; (PL: 21.7 cm; MV: 0.7 cm/sec; 95CEA: 2.4 cm(2)) Significance In older CR patients, the assessment of CoP measures using a force plate shows good to excellent test retest reliability.}, language = {en} } @article{LindenBernertFunkeetal.2017, author = {Linden, Michael and Bernert, Sebastian and Funke, Ariane and Dreinh{\"o}fer, Karsten E. and J{\"o}bges, Michael and von Kardorff, Ernst and Riedel-Heller, Steffi G. and Spyra, Karla and V{\"o}ller, Heinz and Warschburger, Petra and Wippert, Pia-Maria}, title = {Medizinische Rehabilitation unter einer Lifespan-Perspektive}, series = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, volume = {60}, journal = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, publisher = {Springer}, address = {New York}, issn = {1436-9990}, doi = {10.1007/s00103-017-2520-2}, pages = {445 -- 452}, year = {2017}, abstract = {Die Lifespan-Forschung untersucht die Entwicklung von Individuen {\"u}ber den gesamten Lebenslauf. Die medizinische Rehabilitation hat nach geltendem Sozialrecht die Aufgabe, chronische Krankheiten abzuwenden, zu beseitigen, zu mindern, auszugleichen, eine Verschlimmerung zu verh{\"u}ten und Negativfolgen f{\"u}r die Lebensf{\"u}hrung zu reduzieren. Dies erfordert in wissenschaftlicher wie in praxisbezogener Hinsicht die Entwicklung einer Lebensspannenperspektive als Voraussetzung f{\"u}r die Klassifikation und Diagnostik chronischer Erkrankungen, die Beschreibung von verlaufsbeeinflussenden Faktoren, kritischen Lebensphasen und Critical Incidents (kritische Verlaufszeitpunkte), die Durchf{\"u}hrung von prophylaktischen Maßnahmen, die Entwicklung von Assessmentverfahren zur Erfassung und Bewertung von Verl{\"a}ufen oder Vorbehandlungen, die Auswahl und Priorisierung von Interventionen, eine Behandlungs- und Behandlerkoordination auf der Zeitachse, die Pr{\"a}zisierung der Aufgabenstellung f{\"u}r spezialisierte Rehabilitationsmaßnahmen, wie beispielsweise Rehabilitationskliniken, und als Grundlage f{\"u}r die Sozialmedizin. Aufgrund der Vielfalt der individuellen Risikokonstellationen, Krankheitsverl{\"a}ufe und Behandlungssituationen {\"u}ber die Lebensspanne hinweg, bedarf es in der medizinischen Rehabilitation in besonderer Weise einer personalisierten Medizin, die zugleich rehabilitationsf{\"o}rderliche und -behindernde Umweltfaktoren im Rehabilitationsverlauf ber{\"u}cksichtigt.}, language = {de} } @article{HuberTreszlReibisetal.2013, author = {Huber, Matthias and Treszl, Andras and Reibis, Rona Katharina and Teichmann, Christopher and Zergibel, Irina and Bolbrinker, Juliane and Scholze, Juergen and Wegscheider, Karl and V{\"o}ller, Heinz and Kreutz, Reinhold}, title = {Genetics of melatonin receptor type 2 is associated with left ventricular function in hypertensive patients treated according to guidelines}, series = {European journal of internal medicine : official journal of the European Federation of Internal Medicine}, volume = {24}, journal = {European journal of internal medicine : official journal of the European Federation of Internal Medicine}, number = {7}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0953-6205}, doi = {10.1016/j.ejim.2013.03.015}, pages = {650 -- 655}, year = {2013}, abstract = {Background: Melatonin exerts multiple biological effects with potential impact on human diseases. This is underscored by genetic studies that demonstrated associations between melatonin receptor type 2 gene (MTNR1B) polymorphisms and characteristics of type 2 diabetes. We set out to test the hypothesis whether genetic variants at MTNR1B are also relevant for other disease phenotypes within the cardiovascular continuum. We thus investigated single nucleotide polymorphisms (SNPs) of MTNR1B in relation to blood pressure (BP) and cardiac parameters in hypertensive patients. Methods: Patients (n = 605, mean age 56.2 +/- 9.4 years, 82.3\% male) with arterial hypertension and cardiac ejection fraction (EF) >= 40\% were studied. Cardiac parameters were assessed by echocardiography. Results: The cohort comprised subjects with coronary heart disease (73.1\%) and myocardial infarction (48.1\%) with a mean EF of 63.7 +/- 8.9\%. Analysis of SNPs rs10830962, rs4753426, rs12804291, rs10830963, and rs3781638 revealed two haplotypes 1 and 2 with frequencies of 0.402 and 0.277, respectively. Carriers with haplotype 1 (CTCCC) showed compared to non-carriers a higher mean 24-hour systolic BP (difference BP: 2.4 mm Hg, 95\% confidence interval (CI): 0.3 to 4.5 mm Hg, p = 0.023). Haplotype 2 (GCCGA) was significantly related to EF with an absolute increase of 1.8\% (CI: 0.45 to 3.14\%) in carriers versus non-carriers (p = 0.009). Conclusion: Genetics of MTNR1B point to impact of the melatonin signalling pathway for BP and left ventricular function. This may support the importance of the melatonin system as a potential therapeutic target.}, language = {en} } @article{GaedeIlligLimbourgJannowitzetal.2014, author = {Gaede-Illig, Cathleen and Limbourg, T. and Jannowitz, Christina and V{\"o}ller, Heinz}, title = {Predictors of exercise capacity improvement in patients after an acute coronary event during inpatient rehabilitation}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {53}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {5}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0034-1370983}, pages = {341 -- 345}, year = {2014}, abstract = {Zusammenfassung Hintergrund: Patienten mit koronarer Herzkrankheit verfugen uber eine altersentsprechend reduzierte korperliche Leistungsfahigkeit. Um in Abhangigkeit bestehender Patientencharakteristika ein zielgruppenspezifisches Training wahrend kardiologischer Rehabilitation zu ermoglichen, ist die Kenntnis von Einflussgro ss en auf die Steigerung der Leistungsfahigkeit wunschenswert. Methodik: In einem bundesweiten Register (TROL) wurden 47286 Patienten (mittleres Alter: 6411,62 Jahre; 74,5\% Manner) eingeschlossen. Alle Patienten absolvierten zu Beginn und zum Ende der Rehabilitation einen fahrradergometrischen Belastungstest. Als abhangige Variable fur die univariate Analyse und die multivariate logistische Regression galt die Steigerung der Belastbarkeit, die uber einen Cut-off-Wert von 15 Watt Leistungszuwachs definiert wurde. Als Einflussfaktoren gingen Komorbiditaten und eine vor dem Index-Ereignis bestehende korperliche Aktivitat von>90Min/Woche in die Analyse ein. Ergebnisse: Die Leistungssteigerung aktiver im Vergleich zu inaktiven Patienten war signifikant hoher (21,84 Watt vs. 16,35 Watt; p<0,001). Korperliche Aktivitat vor dem Ereignis (Odds Ratio - OR 1,85 [95\% Konfidenzintervall - CI: 1,75-1,97]) sowie mannliches Geschlecht (OR 1,62 [95\% CI: 1,51-1,74]) konnten als positive, Komorbiditaten und Alter (OR 0,82 [95\% CI: 0,74-0,90]) als negative Pradiktoren identifiziert werden. Schlussfolgerung: Zukunftig sollten in kardiologischen Rehabilitationseinrichtungen zielgruppenspezifische Trainingsprogramme eingesetzt werden, die die eingeschrankte Leistungsfahigkeit alterer und durch Komorbiditat limitierter Patienten berucksichtigt. Abstract Objective Patients who suffered from an acute coronary syndrome (ACS) boast a low exercise capacity (EC). To enhance EC is a core component of cardiac rehabilitation (CR). The aim of the study was to investigate predictors of exercise capacity to optimize the rehabilitation process in untrained subgroups. Method: 47286 patients (mean age 6411.62, 74.5\% male) were enclosed in the TROL registry. All patients underwent a bicycle stress test at admission and discharge. The dependent variable for the univariate analysis and multivariate logistic regression was the increase of EC during CR, with a cutoff of 15 Watts (pre/post design). Furthermore comorbidities and physical activity before the index event were analyzed. Results: Exercise capacity enhancement differs between active and inactive patients significantly (21.84 Watt vs. 16.35 Watt; p<0.001). While a male gender (OR 1.62 [95\% CI: 1.51-1.74]) and physical activity before rehabilitation (OR 1.85 [95\% CI: 1.75-1.97]) were positive, comorbidities and age (OR 0.82 [95\% CI: 0.74-0.90]) were negative predictors. Conclusion: In cardiac rehabilitation settings special exercise training programs for elderly and comorbid patients are needed, to enhance their exercise capacity sufficiently.}, language = {en} } @inproceedings{VoellerSalzwedelReibisetal.2014, author = {V{\"o}ller, Heinz and Salzwedel, Annett and Reibis, Rona Katharina and Kaminski, S. and Buhlert, Hermann and Eichler, Sarah and Wegscheider, Karl}, title = {Age and fitness level are strongest limitations of exercise capacity during inpatient cardiac rehabilitation}, series = {European heart journal}, volume = {35}, booktitle = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {899 -- 899}, year = {2014}, language = {en} } @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{SalzwedelNosperRoehrigetal.2014, author = {Salzwedel, Annett and Nosper, Manfred and Roehrig, Bernd and Linck-Eleftheriadis, Sigrid and Strandt, Gert and V{\"o}ller, Heinz}, title = {Outcome quality of in-patient cardiac rehabilitation in elderly patients - identification of relevant parameters}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {21}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {2}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487312469475}, pages = {172 -- 180}, year = {2014}, abstract = {Background: Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome. Methods: From February 2009 to June 2010 1253 patients (70.9 +/- 7.0 years, 78.1\% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation. Results: The majority of patients (61.1\%) were referred for rehabilitation after cardiac surgery, 38.9\% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2\% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale). Conclusion: The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.}, language = {en} } @article{RoehrigNosperLinckEleftheriadisetal.2014, author = {Roehrig, B. and Nosper, M. and Linck-Eleftheriadis, S. and Strandt, G. and Salzwedel, Annett and V{\"o}ller, Heinz}, title = {Method of the assessment of patients Outcome in cardiac rehabilitation by means of quality indicators - a description of the method}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {53}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {1}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0033-1341457}, pages = {31 -- 37}, year = {2014}, abstract = {Introduction: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators. Methods: With EVA-Reha; cardiac rehabilitation the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1\% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed. Results: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators. Conclusion: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population - e.g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers.}, language = {de} } @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} } @misc{SchlittKamkeGuhaetal.2015, author = {Schlitt, Axel and Kamke, Wolfram and Guha, Manju and Haberecht, Olaf and V{\"o}ller, Heinz}, title = {Atrial Fibrillation: The correct Procedure in the cardiac Rehabilitation}, series = {Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft f{\"u}r Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und {\"A}rzte (GDN{\"A})}, volume = {140}, journal = {Deutsche medizinische Wochenschrift : DMW ; Organ der Deutschen Gesellschaft f{\"u}r Innere Medizin (DGIM) ; Organ der Gesellschaft Deutscher Naturforscher und {\"A}rzte (GDN{\"A})}, number = {13}, publisher = {Thieme}, address = {Stuttgart}, issn = {0012-0472}, doi = {10.1055/s-0041-102733}, pages = {1006 -- U100}, year = {2015}, language = {de} } @inproceedings{NitardySalzwedelWegscheideretal.2012, author = {Nitardy, Aischa and Salzwedel, Annett and Wegscheider, Karl and Jawari, Amir and Buhlert, Hermann and V{\"o}ller, Heinz}, title = {Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve replacement}, series = {Circulation : an American Heart Association journal}, volume = {126}, booktitle = {Circulation : an American Heart Association journal}, number = {21}, publisher = {Lippincott Williams \& Wilkins}, address = {Philadelphia}, issn = {0009-7322}, pages = {1}, year = {2012}, language = {en} } @article{ReibisVoellerGittetal.2014, author = {Reibis, Rona Katharina and V{\"o}ller, Heinz and Gitt, Anselm and Jannowitz, Christina and Halle, Martin and Pittrow, David and Hildemann, Steven}, title = {Management of patients with ST- segment elevation or non- ST- segment elevation acute coronary syndromes in cardiac rehabilitation centers}, series = {Clinical cardiology : international journal for cardiovascular diseases}, volume = {37}, journal = {Clinical cardiology : international journal for cardiovascular diseases}, number = {4}, publisher = {Wiley-Blackwell}, address = {Hoboken}, issn = {0160-9289}, doi = {10.1002/clc.22241}, pages = {213 -- 221}, year = {2014}, abstract = {BackgroundCurrent data on the management of patients in cardiac rehabilitation (CR) after an acute hospital stay due to ST-segment elevation or non-ST segment elevation acute coronary syndromes (STE-ACS or NSTE-ACS) are limited. We aimed to describe patient characteristics, risk factor management, and lipid target achievement of patients in CR in Germany and compare the 2 groups. HypothesisWith respect to the risk factor pattern and treatment effects during a CR stay, there are important differences between STE-ACS and NSTE-ACS patients. MethodsComparison of 7950 patients by STE-ACS or NSTE-ACS status in the Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry (2010) who underwent an inpatient CR period of about 3 weeks. ResultsSTE-ACS patients compared to NSTE-ACS patients were significantly younger (60.5 vs 64.4 years, P < 0.0001), and had diabetes mellitus, hypertension, or any risk factor (exception: smoking) less often. At discharge, in STE-ACS compared to NSTE-ACS patients, the low-density lipoprotein cholesterol (LDL-C) <100 mg/dL goal was achieved by 75.3\% and 76.2\%, respectively (LDL-C <70 mg/dL by 27.7\% and 27.4\%), the high-density lipoprotein cholesterol goal of >50 mg/dL in women and >40 mg/dL in men was achieved by 49.3\% and 49.0\%, respectively, and the triglycerides goal of <150 mg/dl was achievedby 72.3\% and 74.3\%, respectively (all comparisons not significant). Mean systolic and diastolic blood pressure were 121/74 and 123/74 mm Hg, respectively (P < 0.0001 systolic, diastolic not significant). The maximum exercise capacity was 110 and 102 W, respectively (P < 0.0001), and the maximum walking distance was 581 and 451 meters, respectively (P value not significant). ConclusionsPatients with STE-ACS and NSTE-ACS differed moderately in their baseline characteristics. Both groups benefited from the participation in CR, as their lipid profile, blood pressure, and physical fitness improved.}, language = {en} } @article{MuellerNordhornMuckelbauerEnglertetal.2014, author = {Mueller-Nordhorn, Jacqueline and Muckelbauer, Rebecca and Englert, Heike and Grittner, Ulrike and Berger, Hendrike and Sonntag, Frank and V{\"o}ller, Heinz and Prugger, Christof and Wegscheider, Karl and Katus, Hugo A. and Willich, Stefan N.}, title = {Longitudinal association between body mass index and health-related quality of life}, series = {PLoS one}, volume = {9}, journal = {PLoS one}, number = {3}, publisher = {PLoS}, address = {San Fransisco}, issn = {1932-6203}, doi = {10.1371/journal.pone.0093071}, pages = {10}, year = {2014}, abstract = {Objective: Health-related quality of life (HRQoL) is an important outcome in individuals with a high risk for cardiovascular diseases. We investigated the association of HRQoL and body mass index (BMI) as an indicator for obesity. Design: Secondary longitudinal analysis of the ORBITAL study, an intervention study which included high-risk cardiovascular primary care patients with hypercholesterolemia and an indication for statin therapy. Methods: HRQoL was determined with the generic Short Form (SF)-12 health status instrument. Body weight and height were assessed at baseline and at months 6, 12, 18, 24, 30, and 36. We used a linear and a linear mixed-effects regression model to investigate the association between BMI and SF-12 summary scores at baseline as well as between change in BMI and SF-12 summary scores over 3 years. We adjusted for age, sex, smoking status, and in the longitudinal analysis also for the study arm and its interaction term with time. Results: Of the 7640 participants who completed the baseline questionnaire, 6726 participants (mean age: 61 years) were analyzed. The baseline BMI was inversely associated with physical and mental SF-12 summary scores (beta [95\% CI] per 1 kg/ m(2) : -0.36 [-0.41; -0.30] and -0.05 [-0.11; -0.00], respectively). A significant association between the change in BMI and physical SF-12 summary scores over time was only present in women (-0.18 [-0.27; -0.09]) and only in obese participants (-0.19 [-0.29; -0.10]). A change in BMI was directly associated with mental SF-12 summary scores (0.12 [0.06; 0.19]) in the total population. Conclusion: Increases in BMI were associated with decreases in physical HRQoL, particularly in obese individuals and in women. In contrast, the mental HRQoL seemed to increase with increasing BMI over time. Thus, body weight management with respect to the HRQoL should be evaluated differentially by sex and body weight status.}, language = {en} } @article{HeneghanWardPereraetal.2012, author = {Heneghan, Carl and Ward, Alison and Perera, Rafael and Bankhead, Clare and Fuller, Alice and Stevens, Richard and Bradford, Kairen and Tyndel, Sally and Alonso-Coello, Pablo and Ansell, Jack and Beyth, Rebecca and Bernardo, Artur and Christensen, Thomas Decker and Cromheecke, Manon and Edson, Robert G and Fitzmaurice, David and Gadisseur, Alain PA and Garcia-Alamino, Josep M and Gardiner, Chris and Hasenkam, Michael and Jacobson, Alan and Kaatz, Scott and Kamali, Farhad and Khan, Tayyaba Irfan and Knight, Eve and Kortke, Heinrich and Levi, Marcel and Matchar, David Bruce and Menendez-Jandula, Barbara and Rakovac, Ivo and Schaefer, Christian and Siebenhofer, Andrea and Souto, Juan Carlos and Sunderji, Rubina and Gin, Kenneth and Shalansky, Karen and V{\"o}ller, Heinz and Wagner, Otto and Zittermann, Armin}, title = {Self-monitoring of oral anticoagulation systematic review and meta-analysis of individual patient data}, series = {The lancet}, volume = {379}, journal = {The lancet}, number = {9813}, publisher = {Elsevier}, address = {New York}, organization = {Self-Monitoring Trialist Collabora}, issn = {0140-6736}, doi = {10.1016/S0140-6736(11)61294-4}, pages = {322 -- 334}, year = {2012}, abstract = {Background Uptake of self-testing and self-management of oral coagulation has remained inconsistent, despite good evidence of their effectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a meta-analysis of individual patient data addressing several important gaps in the evidence, including an estimate of the effect on time to death, first major haemorrhage, and thromboembolism. Methods We searched Ovid versions of Embase (1980-2009) and Medline (1966-2009), limiting searches to randomised trials with a maximally sensitive strategy. We approached all authors of included trials and requested individual patient data: primary outcomes were time to death, first major haemorrhage, and first thromboembolic event. We did prespecified subgroup analyses according to age, type of control-group care (anticoagulation-clinic care vs primary care), self-testing alone versus self-management, and sex. We analysed patients with mechanical heart valves or atrial fibrillation separately. We used a random-effect model method to calculate pooled hazard ratios and did tests for interaction and heterogeneity, and calculated a time-specific number needed to treat. Findings Of 1357 abstracts, we included 11 trials with data for 6417 participants and 12 800 person-years of follow-up. We reported a significant reduction in thromboembolic events in the self-monitoring group (hazard ratio 0.51; 95\% CI 0.31-0.85) but not for major haemorrhagic events (0.88, 0.74-1.06) or death (0.82, 0.62-1.09). Participants younger than 55 years showed a striking reduction in thrombotic events (hazard ratio 0.33, 95\% CI 0.17-0.66), as did participants with mechanical heart valve (0.52, 0.35-0.77). Analysis of major outcomes in the very elderly (age >= 85 years, n=99) showed no significant adverse effects of the intervention for all outcomes. Interpretation Our analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up.}, language = {en} } @unpublished{ReibisGaedeIlligVoeller2014, author = {Reibis, Rona Katharina and Gaede-Illig, Cathleen and V{\"o}ller, Heinz}, title = {Rehabilitation after Acute Myocardial Infarction}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {53}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {3}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0034-1370119}, pages = {191 -- 201}, year = {2014}, language = {de} } @article{MuckelbauerEnglertRieckmannetal.2015, author = {Muckelbauer, Rebecca and Englert, Heike and Rieckmann, Nina and Chen, Chih-Mei and Wegscheider, Karl and V{\"o}ller, Heinz and Katus, Hugo A. and Willich, Stefan N. and M{\"u}ller-Nordhorn, Jacqueline}, title = {Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial}, series = {Preventive medicine : an international journal devoted to practice and theory}, volume = {77}, journal = {Preventive medicine : an international journal devoted to practice and theory}, publisher = {Elsevier}, address = {San Diego}, issn = {0091-7435}, doi = {10.1016/j.ypmed.2015.05.026}, pages = {155 -- 161}, year = {2015}, abstract = {Objective. We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease. Method. Secondary analysis of a randomized controlled trial: In 2002-2004,8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6 months during the 3-year follow-up. Results. In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7\% in the intervention and 21.5\% in the control group. Prevalence decreased in both groups to 16.6\% vs. 19.5\%, 153\% vs. 16.8\%, and 14.2\% vs. 15.6\% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group x time: P = 0.005). The effect was largest after 6 and 12 months [odds ratios (95\% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24 months. Conclusion. A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time. (C) 2015 Elsevier Inc. All rights reserved.}, language = {en} } @article{HofmannVoellerNagelsetal.2015, author = {Hofmann, Reiner and V{\"o}ller, Heinz and Nagels, Klaus and Bindl, Dominik and Vettorazzi, Eik and Dittmar, Ronny and Wohlgemuth, Walter and Neumann, Till and St{\"o}rk, Stefan and Bruder, Oliver and Wegscheider, Karl and Nagel, Eckhard and Fleck, Eckart}, title = {First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure - CardioBBEAT}, series = {Trials}, volume = {16}, journal = {Trials}, publisher = {BioMed Central}, address = {London}, organization = {CardioBBEAT Investigators}, issn = {1745-6215}, doi = {10.1186/s13063-015-0886-8}, pages = {12}, year = {2015}, abstract = {Background: Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Methods: Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva (R)). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months. Results: A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances. Conclusions: CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care. Overall, it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System.}, language = {en} } @article{HuberLeziusReibisetal.2015, author = {Huber, Matthias and Lezius, Susanne and Reibis, Rona Katharina and Treszl, Andras and Kujawinska, Dorota and Jakob, Stefanie and Wegscheider, Karl and V{\"o}ller, Heinz and Kreutz, Reinhold}, title = {A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy}, series = {International journal of molecular sciences}, volume = {16}, journal = {International journal of molecular sciences}, number = {8}, publisher = {MDPI}, address = {Basel}, issn = {1422-0067}, doi = {10.3390/ijms160817456}, pages = {17456 -- 17468}, year = {2015}, abstract = {Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 +/- 9.8 years, 83\% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) 40\% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7\%) and myocardial infarction (n = 545; 54.1\%) with a mean LVEF of 59.9\% +/- 9.3\%. The mean left ventricular mass index (LVMI) was 52.1 +/- 21.2 g/m(2.7) and 485 (48.2\%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7\% increase in LVMI (95\% CI: 1\%-12\%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.}, language = {en} } @inproceedings{VoellerSalzwedelReibisetal.2015, author = {V{\"o}ller, Heinz and Salzwedel, Annett and Reibis, Rona Katharina and Eichler, Sarah and Buhlert, Hermann and Kaminski, Stefan and Wegscheider, Karl}, title = {Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation}, series = {European heart journal}, volume = {36}, booktitle = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {635 -- 636}, year = {2015}, language = {en} } @inproceedings{VoellerEichlerHarnathetal.2015, author = {V{\"o}ller, Heinz and Eichler, Sarah and Harnath, Axel and Kamke, Wolfram and Butter, Christian and Kraehe, Mathias and Schikora, Martin and Jachczyk, J. and Salzwedel, Annett}, title = {Case management in patients after TAVI: are frailty and exercise capacitiy predictors for decision making process?}, series = {European heart journal}, volume = {36}, booktitle = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {635 -- 635}, year = {2015}, language = {en} } @article{RingwaldLehmannNiemeyeretal.2014, author = {Ringwald, Juergen and Lehmann, Marina and Niemeyer, Nicole and Seifert, Isabel and Daubmann, Anne and Wegscheider, Karl and Salzwedel, Annett and Luxembourg, Beate and Eckstein, Reinhold and V{\"o}ller, Heinz}, title = {Travel habits and complications in patients treated with vitamin K antagonists: A cross sectional analysis}, series = {Travel medicine and infectious disease}, volume = {12}, journal = {Travel medicine and infectious disease}, number = {3}, publisher = {Elsevier}, address = {Oxford}, issn = {1477-8939}, doi = {10.1016/j.tmaid.2014.02.006}, pages = {258 -- 263}, year = {2014}, abstract = {Background: Travel-related conditions have impact on the quality of oral anticoagulation therapy (OAT) with vitamin K-antagonists. No predictors for travel activity and for travel-associated haemorrhage or thromboembolic complications of patients on OAT are known. Methods: A standardised questionnaire was sent to 2500 patients on long-term OAT in Austria, Switzerland and Germany. 997 questionnaires were received (responder rate 39.9\%). Ordinal or logistic regression models with travel activity before and after onset of OAT or travel-associated haemorrhages and thromboembolic complications as outcome measures were applied. Results: 43.4\% changed travel habits since onset of OAT with 24.9\% and 18.5\% reporting decreased or increased travel activity, respectively. Long-distance worldwide before OAT or having suffered from thromboembolic complications was associated with reduced travel activity. Increased travel activity was associated with more intensive travel experience, increased duration of OAT, higher education, or performing patient self-management (PSM). Travel-associated haemorrhages or thromboennbolic complications were reported by 6.5\% and 0.9\% of the patients, respectively. Former thromboennbolic complications, former bleedings and PSM were significant predictors of travel-associated complications. Conclusions: OAT also increases travel intensity. Specific medical advice prior travelling to prevent complications should be given especially to patients with former bleedings or thromboennbolic complications and to those performing PSM. (C) 2014 Elsevier Ltd. All rights reserved.}, language = {en} } @article{SalzwedelRieckReibisetal.2015, author = {Salzwedel, Annett and Rieck, Angelika and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {Routine initial exercise stress testing for treatment stratification in comprehensive cardiac rehabilitation}, series = {International journal of rehabilitation research}, volume = {38}, journal = {International journal of rehabilitation research}, number = {4}, publisher = {Lippincott Williams \& Wilkins}, address = {Philadelphia}, issn = {0342-5282}, doi = {10.1097/MRR.0000000000000133}, pages = {344 -- 349}, year = {2015}, abstract = {There is evidence of substantial benefit of cardiac rehabilitation (CR) for patients with low exercise capacity at admission. Nevertheless, some patients are not able to perform an initial exercise stress test (EST). We aimed to describe this group using data of 1094 consecutive patients after a cardiac event (71 +/- 7 years, 78\% men) enrolled in nine centres for inpatient CR. We analysed sociodemographic and clinical variables (e.g. cardiovascular risk factors, comorbidities, complications at admission), amount of therapy (e.g. exercise training, nursing care) and the results of the initial and the final 6-min walking test (6MWT) with respect to the application of an EST. Fifteen per cent of patients did not undergo an EST (non-EST group). In multivariable analysis, the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89, P=0.01], a 6MWT (per 10 m, OR 1.07, P<0.01) and lower for patients with diabetes mellitus (OR 0.48, P<0.01), NYHA-class III/IV (OR 0.27, P<0.01), osteoarthritis (OR 0.39, P<0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The non-EST group received fewer therapy units of exercise training, but more units of nursing care and physiotherapy than the EST group. However, there were no significant differences between both groups in the increase of the 6MWT during CR (123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at the start of CR as an indicator of disease severity. Nevertheless, patients without EST benefit from CR even if exercising less. Thus, there is a justified need for individualized, comprehensive and interdisciplinary CR.}, language = {en} } @article{VoellerGittJannowitzetal.2014, author = {V{\"o}ller, Heinz and Gitt, Anselm and Jannowitz, Christina and Karoff, Marthin and Karmann, Barbara and Pittrow, David and Reibis, Rona Katharina and Hildemann, Steven}, title = {Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {21}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {9}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487313482285}, pages = {1125 -- 1133}, year = {2014}, abstract = {Background: Chronic kidney disease (CKD) is a frequent comorbidity among elderly patients and those with cardiovascular disease. CKD carries prognostic relevance. We aimed to describe patient characteristics, risk factor management and control status of patients in cardiac rehabilitation (CR), differentiated by presence or absence of CKD. Design and methods: Data from 92,071 inpatients with adequate information to calculate glomerular filtration rate (GFR) based on the Cockcroft-Gault formula were analyzed at the beginning and the end of a 3-week CR stay. CKD was defined as estimated GFR <60 ml/min/1.73 m(2). Results: Compared with non-CKD patients, CKD patients were significantly older (72.0 versus 58.0 years) and more often had diabetes mellitus, arterial hypertension, and atherothrombotic manifestations (previous stroke, peripheral arterial disease), but fewer were current or previous smokers had a CHD family history. Exercise capacity was much lower in CKD (59 vs. 92Watts). Fewer patients with CKD were treated with percutaneous coronary intervention (PCI), but more had coronary artery bypass graft (CABG) surgery. Patients with CKD compared with non-CKD less frequently received statins, acetylsalicylic acid (ASA), clopidogrel, beta blockers, and angiotensin converting enzyme (ACE) inhibitors, and more frequently received angiotensin receptor blockers, insulin and oral anticoagulants. In CKD, mean low density lipoprotein cholesterol (LDL-C), total cholesterol, and high density lipoprotein cholesterol (HDL-C) were slightly higher at baseline, while triglycerides were substantially lower. This lipid pattern did not change at the discharge visit, but overall control rates for all described parameters (with the exception of HDL-C) were improved substantially. At discharge, systolic blood pressure (BP) was higher in CKD (124 versus 121 mmHg) and diastolic BP was lower (72 versus 74 mmHg). At discharge, 68.7\% of CKD versus 71.9\% of non-CKD patients had LDL-C <100 mg/dl. Physical fitness on exercise testing improved substantially in both groups. When the Modification of Diet in Renal Disease (MDRD) formula was used for CKD classification, there was no clinically relevant change in these results. Conclusion: Within a short period of 3-4 weeks, CR led to substantial improvements in key risk factors such as lipid profile, blood pressure, and physical fitness for all patients, even if CKD was present.}, language = {en} } @article{DissmannCrommeSalzwedeletal.2014, author = {Dissmann, R. and Cromme, L. J. and Salzwedel, Annett and Taborski, U. and Kunath, J. and Gaebler, F. and Heyne, K. and V{\"o}ller, Heinz}, title = {Computer aided dosage management of phenprocoumon anticoagulation therapy Clinical validation}, series = {H{\"a}mostaseologie : Organ der Gesellschaft f{\"u}r Thrombose- und H{\"a}mostaseforschung e.V. (GTH)}, volume = {34}, journal = {H{\"a}mostaseologie : Organ der Gesellschaft f{\"u}r Thrombose- und H{\"a}mostaseforschung e.V. (GTH)}, number = {3}, publisher = {Schattauer}, address = {Stuttgart}, issn = {0720-9355}, doi = {10.5482/HAMO-13-06-0030}, pages = {226 -- 232}, year = {2014}, abstract = {A recently developed multiparameter computer-aided expert system (TheMa) for guiding anticoagulation with phenprocoumon (PPC) was validated by a prospective investigation in 22 patients. The PPC-INR-response curve resulting from physician guided dosage was compared to INR values calculated by "twin calculation" from TheMa recommended dosage. Additionally, TheMa was used to predict the optimal time to perform surgery or invasive procedures after interruption of anticogulation therapy. Results: Comparison of physician and TheMa guided anticoagulation showed almost identical accuracy by three quantitative measures: Polygon integration method (area around INR target) 616.17 vs. 607.86, INR hits in the target range 166 vs. 161, and TTR (time in therapeutic range) 63.91 vs. 62.40 \%. After discontinuation of anticoagulation therapy, calculating the INR phase-out curve with TheMa INR prognosis of 1.8 was possible with a standard deviation of 0.50 +/- 0.59 days. Conclusion: Guiding anticoagulation with TheMa was as accurate as Physician guided therapy. After interruption of anticoagulant therapy, TheMa may be used for calculating the optimal time performing operations or initiating bridging therapy.}, language = {de} } @article{ReibisKuehlSalzwedeletal.2017, author = {Reibis, Rona Katharina and K{\"u}hl, Uwe and Salzwedel, Annett and Rasawieh, Mortesa and Eichler, Sarah and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Return to work in heart failure patients with suspected viral myocarditis}, series = {SAGE Open Medicine}, volume = {5}, journal = {SAGE Open Medicine}, publisher = {Sage}, address = {Thousand Oaks, Calif.}, issn = {2050-3121}, doi = {10.1177/2050312117744978}, year = {2017}, abstract = {Background: Endomyocardial biopsy is considered as the gold standard in patients with suspected myocarditis. We aimed to evaluate the impact of bioptic findings on prediction of successful return to work. Methods: In 1153 patients (48.9 ± 12.4 years, 66.2\% male), who were hospitalized due to symptoms of left heart failure between 2005 and 2012, an endomyocardial biopsy was performed. Routine clinical and laboratory data, sociodemographic parameters, and noninvasive and invasive cardiac variables including endomyocardial biopsy were registered. Data were linked with return to work data from the German statutory pension insurance program and analyzed by Cox regression. Results: A total of 220 patients had a complete data set of hospital and insurance information. Three quarters of patients were virus-positive (54.2\% parvovirus B19, other or mixed infection 16.7\%). Mean invasive left ventricular ejection fraction was 47.1\% ± 18.6\% (left ventricular ejection fraction <45\% in 46.3\%). Return to work was achieved after a mean interval of 168.8 ± 347.7 days in 220 patients (after 6, 12, and 24 months in 61.3\%, 72.2\%, and 76.4\%). In multivariate regression analysis, only age (per 10 years, hazard ratio, 1.27; 95\% confidence interval, 1.10-1.46; p = 0.001) and left ventricular ejection fraction (per 5\% increase, hazard ratio, 1.07; 95\% confidence interval, 1.03-1.12; p = 0.002) were associated with increased, elevated work intensity (heavy vs light, congestive heart failure, 0.58; 95\% confidence interval, 0.34-0.99; p < 0.049) with decreased probability of return to work. None of the endomyocardial biopsy-derived parameters was significantly associated with return to work in the total group as well as in the subgroup of patients with biopsy-proven myocarditis. Conclusion: Added to established predictors, bioptic data demonstrated no additional impact for return to work probability. Thus, socio-medical evaluation of patients with suspected myocarditis furthermore remains an individually oriented process based primarily on clinical and functional parameters.}, language = {en} } @misc{ReibisKuehlSalzwedeletal.2018, author = {Reibis, Rona Katharina and K{\"u}hl, Uwe and Salzwedel, Annett and Rasawieh, Mortesa and Eichler, Sarah and Wegscheider, Karl and V{\"o}ller, Heinz}, title = {Return to work in heart failure patients with suspected viral myocarditis}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, volume = {5}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {378}, issn = {1866-8364}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-407637}, year = {2018}, abstract = {Background: Endomyocardial biopsy is considered as the gold standard in patients with suspected myocarditis. We aimed to evaluate the impact of bioptic findings on prediction of successful return to work. Methods: In 1153 patients (48.9 ± 12.4 years, 66.2\% male), who were hospitalized due to symptoms of left heart failure between 2005 and 2012, an endomyocardial biopsy was performed. Routine clinical and laboratory data, sociodemographic parameters, and noninvasive and invasive cardiac variables including endomyocardial biopsy were registered. Data were linked with return to work data from the German statutory pension insurance program and analyzed by Cox regression. Results: A total of 220 patients had a complete data set of hospital and insurance information. Three quarters of patients were virus-positive (54.2\% parvovirus B19, other or mixed infection 16.7\%). Mean invasive left ventricular ejection fraction was 47.1\% ± 18.6\% (left ventricular ejection fraction <45\% in 46.3\%). Return to work was achieved after a mean interval of 168.8 ± 347.7 days in 220 patients (after 6, 12, and 24 months in 61.3\%, 72.2\%, and 76.4\%). In multivariate regression analysis, only age (per 10 years, hazard ratio, 1.27; 95\% confidence interval, 1.10-1.46; p = 0.001) and left ventricular ejection fraction (per 5\% increase, hazard ratio, 1.07; 95\% confidence interval, 1.03-1.12; p = 0.002) were associated with increased, elevated work intensity (heavy vs light, congestive heart failure, 0.58; 95\% confidence interval, 0.34-0.99; p < 0.049) with decreased probability of return to work. None of the endomyocardial biopsy-derived parameters was significantly associated with return to work in the total group as well as in the subgroup of patients with biopsy-proven myocarditis. Conclusion: Added to established predictors, bioptic data demonstrated no additional impact for return to work probability. Thus, socio-medical evaluation of patients with suspected myocarditis furthermore remains an individually oriented process based primarily on clinical and functional parameters.}, language = {en} } @misc{RauchDavosDohertyetal.2016, author = {Rauch, Bernhard and Davos, Constantinos H. and Doherty, Patrick and Saure, Daniel and Metzendorf, Maria-Inti and Salzwedel, Annett and V{\"o}ller, Heinz and Jensen, Katrin and Schmid, Jean-Paul}, title = {The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {418}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-405346}, pages = {26}, year = {2016}, abstract = {Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95\% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95\% CI 0.49-0.84; odds ratio 0.20, 95\% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95\% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.}, language = {en} } @article{SalzwedelReibisWegscheideretal.2016, author = {Salzwedel, Annett and Reibis, Rona Katharina and Wegscheider, Karl and Eichler, Sarah and Buhlert, Hermann and Kaminski, Stefan and V{\"o}ller, Heinz}, title = {Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation}, series = {Clinical research in cardiology : official journal of the German Cardiac Society.}, volume = {105}, journal = {Clinical research in cardiology : official journal of the German Cardiac Society.}, publisher = {Springer}, address = {Heidelberg}, issn = {1861-0684}, doi = {10.1007/s00392-015-0917-1}, pages = {257 -- 267}, year = {2016}, abstract = {Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. We analyzed data from a registry of 489 working-age patients (51.5 +/- A 6.9 years, 87.9 \% men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 \%), coronary artery bypass graft (CABG 17.2 \%), or heart valve replacement (9.0 \%). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. During a mean follow-up of 26.5 +/- A 11.9 months, 373 (76.3 \%) patients returned to work, 116 (23.7 \%) did not, and 60 (12.3 \%) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 \% CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 \% CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 \% CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 \% CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 \% CI 0.30-0.82; p = 0.006).}, language = {en} } @article{ReibisSalzwedelBuhlertetal.2016, author = {Reibis, Rona Katharina and Salzwedel, Annett and Buhlert, Hermann and Wegscheider, Karl and Eichler, Sarah and V{\"o}ller, Heinz}, title = {Impact of training methods and patient characteristics on exercise capacity in patients in cardiovascular rehabilitation}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {23}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487315600815}, pages = {452 -- 459}, year = {2016}, abstract = {Aim We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training methods for training achievements and final fitness of CR patients. Methods We studied 557 consecutive patients (51.76.9 years; 87.9\% men) admitted to a three-week in-patient CR. Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training volume and final physical fitness (assessed by peak O-2 utilization (VO2peak) were analysed using analysis of covariance (ANCOVA) models. Results Mean training intensity was 90.7 +/- 9.7\% of maximum heart rate (81\% continuous/19\% interval training, 64\% additional strength training). A total of 12.2 +/- 2.6 bicycle exercise training sessions were performed. Increase of training volume by an average of more than 100\% was achieved (difference end/beginning of CR: 784 +/- 623 wattsxmin). In the multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO2peak was mainly dependent on age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and training method. Conclusion CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on various factors associated with training, which supports the recommendation that CR should be offered to all cardiac patients.}, language = {en} } @misc{VoellerEichlerHarnathetal.2016, author = {V{\"o}ller, Heinz and Eichler, Sarah and Harnath, A. and Nothroff, J{\"o}rg and Butter, Christian and Schikora, Martin and Wegscheider, Karl and Salzwedel, Annett}, title = {Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation (TAVI) - course of functioning and quality of life}, series = {European heart journal}, volume = {37}, journal = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {542 -- 542}, year = {2016}, language = {en} } @misc{VoellerHeidlerRiecketal.2016, author = {V{\"o}ller, Heinz and Heidler, Maria-Dorothea and Rieck, Angelika and Schikora, Martin and Haubold, Kathrin and Joebges, Michael and Salzwedel, Annett}, title = {Prevalence of mild cognitive impairment in patients after an acute coronary syndrome in cardiac rehabilitation}, series = {European heart journal}, volume = {37}, journal = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {543 -- 543}, year = {2016}, language = {en} } @misc{DavosDohertyVolleretal.2016, author = {Davos, C. H. and Doherty, P. and Voller, Heinz and Salzwedel, Annett and Saure, D. and Metzendorf, M. I. and Jensen, K. and Schmid, J. P. and Rauch, B.}, title = {The prognostic effect of cardiac rehabilitation in the era of acute revascularization and statin therapy: the cardiac rehabilitation outcome study (CROS)}, series = {European heart journal}, volume = {37}, journal = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {645 -- 645}, year = {2016}, language = {en} } @misc{ReibisKuehlSalzwedeletal.2016, author = {Reibis, R. and Kuehl, U. and Salzwedel, Annett and Rasawieh, M. and Wegschweider, K. and V{\"o}ller, Heinz}, title = {Return to work after endomyocardial biopsy in patients with suspected viral myocarditis}, series = {European heart journal}, volume = {37}, journal = {European heart journal}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {0195-668X}, pages = {728 -- 728}, year = {2016}, language = {en} } @misc{RauchDavosDohertyetal.2016, author = {Rauch, Bernhard and Davos, Constantinos H. and Doherty, Patrick and Saure, Daniel and Metzendorf, Maria-Inti and Salzwedel, Annett and V{\"o}ller, Heinz and Jensen, Katrin and Schmid, Jean-Paul}, title = {The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS)}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {23}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, publisher = {Sage Publ.}, address = {London}, organization = {Univ Heidelberg; Heinrich-Heine Univ}, issn = {2047-4873}, doi = {10.1177/2047487316671181}, pages = {1914 -- 1939}, year = {2016}, abstract = {Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95\% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95\% CI 0.49-0.84; odds ratio 0.20, 95\% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95\% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.}, language = {en} } @article{ReibisSchlittGlatzetal.2016, author = {Reibis, Rona Katharina and Schlitt, A. and Glatz, J. and Langheim, E. H. and Guha, M. and Halle, M. and Boscheri, A. and Hegeler-Molkewehrum, C. and V{\"o}ller, Heinz}, title = {Rehabilitation in Heart Failure}, series = {Die Rehabilitation : Zeitschrift f{\~A}¼r Praxis und Forschung in der Rehabilitation}, volume = {55}, journal = {Die Rehabilitation : Zeitschrift f{\~A}¼r Praxis und Forschung in der Rehabilitation}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0042-103302}, pages = {115 -- 129}, year = {2016}, abstract = {Kernaussagen: - Patienten mit Herzinsuffizienz (HF-rEF, HF-pEF oder in Kombination) stellen einen relevanten Anteil von Patienten in kardiologischen Rehabilitationseinrichtungen dar. Sie erfordern aufgrund der eingeschr{\"a}nkten Ventrikelfunktion, der Arrhythmieneigung sowie den h{\"a}ufig implantierten elektrischen Aggregaten ein multimodales Therapiekonzept. - Neben der leitlinienorientierten Pharmakotherapie nehmen die individualisierte Trainingstherapie und die psychosoziale Betreuung tragende Funktionen in der Rehabilitation herzinsuffizienter Patienten ein. - Die berufliche Wiedereingliederung wird durch die h{\"a}modynamische Stabilit{\"a}t, die kognitiven Leistungen, die Arbeitsplatzanforderungen und Arbeitsplatzsicherheit insbesondere bei ICD/CRT-Tr{\"a}gern determiniert. - Die Fahreignung wird {\"u}berwiegend in Einzelfallentscheidungen bestimmt und richtet sich u. a. nach der linksventrikul{\"a}ren Pumpleistung und dem arrhythmiefreien Intervall.}, language = {de} } @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} } @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} } @article{RoehrigSalzwedelLinckEleftheriadisetal.2015, author = {R{\"o}hrig, Bernd and Salzwedel, Annett and Linck-Eleftheriadis, Sigrid and V{\"o}ller, Heinz and Nosper, Manfred}, title = {Outcome Based Center Comparisons in Inpatient Cardiac Rehabilitation Results from the EVA-Reha (R) Cardiology Project}, series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, volume = {54}, journal = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation}, number = {1}, publisher = {Thieme}, address = {Stuttgart}, issn = {0034-3536}, doi = {10.1055/s-0034-1395556}, pages = {45 -- 52}, year = {2015}, abstract = {Background: So far, for center comparisons in inpatient cardiac rehabilitation (CR), the objective outcome quality was neglected because of challenges in quantifying the overall success of CR. In this article, a multifactorial benchmark model measuring the individual rehabilitation success is presented. Methods: In 21 rehabilitation centers, 5 123 patients were consecutively enrolled between 01/2010 and 12/2012 in the prospective multicenter registry EVA-Reha (R) Cardiology. Changes in 13 indicators in the areas cardiovascular risk factors, physical performance and subjective health during rehabilitation were evaluated according to levels of severity. Changes were only rated for patients who needed a medical intervention. Additionally, the changes had to be clinically relevant. Therefore Minimal Important Differences (MID) were predefined. Ratings were combined to a single score, the multiple outcome criterion (MEK). Results: The MEK was determined for all patients (71.7 +/- 7.4 years, 76.9 \% men) and consisted of an average of 5.6 indicators. After risk adjustment for sociodemographic and clinical baseline parameters, MEK was used for center ranking. In addition, individual results of indicators were compared with means of all study sites. Conclusion: With the method presented here, the outcome quality can be quantified and outcome-based comparisons of providers can be made.}, language = {de} } @article{ReibisJannowitzHalleetal.2015, author = {Reibis, Rona Katharina and Jannowitz, Christina and Halle, Martin and Pittrow, David and Gitt, Anselm and V{\"o}ller, Heinz}, title = {Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers}, series = {Current medical research and opinion}, volume = {31}, journal = {Current medical research and opinion}, number = {2}, publisher = {Taylor \& Francis Group}, address = {London}, issn = {0300-7995}, doi = {10.1185/03007995.2014.977854}, pages = {211 -- 219}, year = {2015}, abstract = {Background: We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events. Methods: Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3\%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7\%) who underwent an inpatient CR period of about 3 weeks in 2009-2010. Results: Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p<0.0001), and more often had risk factors such as diabetes mellitus (39.7\% vs. 32.0\%, p<0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4\%), and reduced in patients with low EF compared to those with normal EF (47.7\% vs. 55.5\%, p<0.0001). The rate of patients that achieved lower LDL cholesterol (5100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p<0.0001) and at discharge (119/72 vs. 124/74 mmHg, p<0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p<0.0001; at discharge 85 vs. 105 Watts, p<0.0001). Event rates during CR were low, and only 0.3\% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay. Conclusions: Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved.}, language = {en} } @article{HeidlerBiduFriedrichetal.2015, author = {Heidler, Maria-Dorothea and Bidu, Laura and Friedrich, Nele and V{\"o}ller, Heinz}, title = {Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia}, series = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, volume = {110}, journal = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, number = {1}, publisher = {Springer}, address = {New York}, issn = {2193-6218}, doi = {10.1007/s00063-014-0397-5}, pages = {55 -- 60}, year = {2015}, abstract = {In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 \% of the patients aspirated, 71 \% of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.}, language = {de} } @article{SalzwedelRabeZahnetal.2017, author = {Salzwedel, Annett and Rabe, Sophie and Zahn, Thomas and Neuwirth, Julia and Eichler, Sarah and Haubold, Kathrin and Wachholz, Anne and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {User Interest in Digital Health Technologies to Encourage Physical Activity}, series = {JMIR. Mhealth \& Uhealth}, volume = {5}, journal = {JMIR. Mhealth \& Uhealth}, number = {4}, publisher = {JMIR Publications}, address = {Toronto}, doi = {10.2196/mhealth.7192}, year = {2017}, abstract = {Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30\%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5\%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1\% (340/485) of employees and 52.67\% (641/1217) of students. Within these groups, 53.2\% (341/641 students) and 44.2\% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle.}, language = {en} } @misc{SalzwedelRabeZahnetal.2017, author = {Salzwedel, Annett and Rabe, Sophie and Zahn, Thomas and Neuwirth, Julia and Eichler, Sarah and Haubold, Kathrin and Wachholz, Anne and Reibis, Rona Katharina and V{\"o}ller, Heinz}, title = {User Interest in Digital Health Technologies to Encourage Physical Activity}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-401872}, pages = {8}, year = {2017}, abstract = {Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30\%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5\%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1\% (340/485) of employees and 52.67\% (641/1217) of students. Within these groups, 53.2\% (341/641 students) and 44.2\% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle.}, language = {en} } @misc{VoellerGittJannowitzetal.2014, author = {V{\"o}ller, Heinz and Gitt, Anselm and Jannowitz, Christina and Karoff, Marthin and Karmann, Barbara and Pittrow, David and Reibis, Rona Katharina and Hildemann, Steven}, title = {Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {381}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-404065}, pages = {9}, year = {2014}, abstract = {Background: Chronic kidney disease (CKD) is a frequent comorbidity among elderly patients and those with cardiovascular disease. CKD carries prognostic relevance. We aimed to describe patient characteristics, risk factor management and control status of patients in cardiac rehabilitation (CR), differentiated by presence or absence of CKD. Design and methods: Data from 92,071 inpatients with adequate information to calculate glomerular filtration rate (GFR) based on the Cockcroft-Gault formula were analyzed at the beginning and the end of a 3-week CR stay. CKD was defined as estimated GFR <60 ml/min/1.73 m(2). Results: Compared with non-CKD patients, CKD patients were significantly older (72.0 versus 58.0 years) and more often had diabetes mellitus, arterial hypertension, and atherothrombotic manifestations (previous stroke, peripheral arterial disease), but fewer were current or previous smokers had a CHD family history. Exercise capacity was much lower in CKD (59 vs. 92Watts). Fewer patients with CKD were treated with percutaneous coronary intervention (PCI), but more had coronary artery bypass graft (CABG) surgery. Patients with CKD compared with non-CKD less frequently received statins, acetylsalicylic acid (ASA), clopidogrel, beta blockers, and angiotensin converting enzyme (ACE) inhibitors, and more frequently received angiotensin receptor blockers, insulin and oral anticoagulants. In CKD, mean low density lipoprotein cholesterol (LDL-C), total cholesterol, and high density lipoprotein cholesterol (HDL-C) were slightly higher at baseline, while triglycerides were substantially lower. This lipid pattern did not change at the discharge visit, but overall control rates for all described parameters (with the exception of HDL-C) were improved substantially. At discharge, systolic blood pressure (BP) was higher in CKD (124 versus 121 mmHg) and diastolic BP was lower (72 versus 74 mmHg). At discharge, 68.7\% of CKD versus 71.9\% of non-CKD patients had LDL-C <100 mg/dl. Physical fitness on exercise testing improved substantially in both groups. When the Modification of Diet in Renal Disease (MDRD) formula was used for CKD classification, there was no clinically relevant change in these results. Conclusion: Within a short period of 3-4 weeks, CR led to substantial improvements in key risk factors such as lipid profile, blood pressure, and physical fitness for all patients, even if CKD was present.}, language = {en} } @article{EichlerRabeSalzwedeletal.2017, author = {Eichler, Sarah and Rabe, Sophie and Salzwedel, Annett and M{\"u}ller, Steffen and Stoll, Josefine and Tilgner, Nina and John, Michael and Wegschneider, Karl and Mayer, Frank and V{\"o}ller, Heinz}, title = {Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement}, series = {Trials}, volume = {18}, journal = {Trials}, publisher = {BioMed Central}, address = {London}, issn = {1745-6215}, doi = {10.1186/s13063-017-2173-3}, pages = {1 -- 7}, year = {2017}, abstract = {Background Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.}, language = {en} } @misc{EichlerRabeSalzwedeletal.2017, author = {Eichler, Sarah and Rabe, Sophie and Salzwedel, Annett and M{\"u}ller, Steffen and Stoll, Josefine and Tilgner, Nina and John, Michael and Wegschneider, Karl and Mayer, Frank and V{\"o}ller, Heinz}, title = {Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-403702}, pages = {7}, year = {2017}, abstract = {Background Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.}, language = {en} } @misc{HuberLeziusReibisetal., author = {Huber, Matthias and Lezius, Susanne and Reibis, Rona Katharina and Treszl, Andras and Kujawinska, Dorota and Jakob, Stefanie and Wegscheider, Karl and V{\"o}ller, Heinz and Kreutz, Reinhold}, title = {A single nucleotide polymorphism near the CYP17A1 gene is associated with left ventricular mass in hypertensive patients under pharmacotherapy}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-400074}, pages = {13}, abstract = {Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83\% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥40\% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7\%) and myocardial infarction (n = 545; 54.1\%) with a mean LVEF of 59.9\% ± 9.3\%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2\%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7\% increase in LVMI (95\% CI: 1\%-12\%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.}, language = {en} } @article{VigoritoAbreuAmbrosettietal.2017, author = {Vigorito, Carlo and Abreu, Ana and Ambrosetti, Marco and Belardinelli, Romualdo and Corra, Ugo and Cupples, Margaret and Davos, Constantinos H. and Hoefer, Stefan and Iliou, Marie-Christine and Schmid, Jean-Paul and V{\"o}ller, Heinz and Doherty, Patrick}, title = {Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {24}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487316682579}, pages = {577 -- 590}, year = {2017}, abstract = {Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.}, language = {en} } @article{HansenDendaleConinxetal.2017, author = {Hansen, Dominique and Dendale, Paul and Coninx, Karin and Vanhees, Luc and Piepoli, Massimo F. and Niebauer, Josef and Cornelissen, Veronique and Pedretti, Roberto and Geurts, Eva and Ruiz, Gustavo R. and Corra, Ugo and Schmid, Jean-Paul and Greco, Eugenio and Davos, Constantinos H. and Edelmann, Frank and Abreu, Ana and Rauch, Bernhard and Ambrosetti, Marco and Braga, Simona S. and Barna, Olga and Beckers, Paul and Bussotti, Maurizio and Fagard, Robert and Faggiano, Pompilio and Garcia-Porrero, Esteban and Kouidi, Evangelia and Lamotte, Michel and Neunhaeuserer, Daniel and Reibis, Rona Katharina and Spruit, Martijn A. and Stettler, Christoph and Takken, Tim and Tonoli, Cajsa and Vigorito, Carlo and V{\"o}ller, Heinz and Doherty, Patrick}, title = {The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {24}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, publisher = {Sage Publ.}, address = {London}, issn = {2047-4873}, doi = {10.1177/2047487317702042}, pages = {1017 -- 1031}, year = {2017}, abstract = {Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.}, language = {en} } @article{ReibisVoeller2020, author = {Reibis, Rona K. and V{\"o}ller, Heinz}, title = {Non pharmacological secondary prevention and rehabilitation}, series = {Aktuelle Kardiologie}, volume = {9}, journal = {Aktuelle Kardiologie}, number = {03}, publisher = {Thieme}, address = {Stuttgart}, issn = {2193-5203}, doi = {10.1055/a-1185-8460}, pages = {297 -- 302}, year = {2020}, abstract = {Die Sekund{\"a}rpr{\"a}vention der koronaren Herzkrankheit umfasst einerseits eine pharmakologische, andererseits eine lebensstilbasierte S{\"a}ule, die idealerweise interagieren und sich potenzieren. Neben der medikament{\"o}sen Blutdruck- und Lipideinstellung auf leitlinienorientierte Zielwerte erm{\"o}glichen moderne Antidiabetika eine Optimierung des glukometabolischen Kontinuums und eine Prognosebesserung. Die Lebensstiloptimierung setzt sich aus koronarprotektiver Ern{\"a}hrung, einer individualisierten Trainingstherapie, einer konsequenten Nikotinkarenz und stressreduzierenden Maßnahmen zusammen. Die kardiologische Rehabilitation (Phase II) schließt sich idealerweise unmittelbar einem station{\"a}ren Aufenthalt wegen eines akuten Koronarereignisses an, kann aber auch im Rahmen einer stabilen Koronarsituation im Rahmen eines allgemeinen Antragsverfahrens durchgef{\"u}hrt werden. Randomisierte und prospektiv angelegte Interventionsstudien belegen die prognostische Wertigkeit der kardiologischen Rehabilitation auch im Zeitalter akuter Revaskularisationstherapie mit 24-h-PCI und moderner Pharmakotherapie.}, language = {de} } @article{SchwaabRauchVoelleretal.2020, author = {Schwaab, Bernhard and Rauch, Bernhard and V{\"o}ller, Heinz and Benzer, Werner and Schmid, Jean-Paul}, title = {Beyond randomised studies}, series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, volume = {28}, journal = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology}, number = {17}, publisher = {Oxford Univ. Press}, address = {Oxford}, issn = {2047-4873}, doi = {10.1177/2047487320936782}, pages = {E17 -- E19}, year = {2020}, language = {en} } @article{SalzwedelVoeller2021, author = {Salzwedel, Annett and V{\"o}ller, Heinz}, title = {Cardiac rehabilitation}, series = {Deutsches {\"A}rzteblatt international : a weekly online journal of clinical medicine and public health}, volume = {118}, journal = {Deutsches {\"A}rzteblatt international : a weekly online journal of clinical medicine and public health}, number = {29-30}, publisher = {Dt. {\"A}rzte-Verl.}, address = {Cologne}, organization = {OutCaRe Investigators}, issn = {1866-0452}, doi = {10.3238/arztebl.m2021.0211}, pages = {505 -- 506}, year = {2021}, language = {en} } @misc{VerchStollHadzicetal.2021, author = {Verch, Ronald and Stoll, Josefine and Hadzic, Miralem and Quarmby, Andrew and V{\"o}ller, Heinz}, title = {Whole-Body EMS Superimposed Walking and Nordic Walking on a Treadmill—Determination of Exercise Intensity to Conventional Exercise}, series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, publisher = {Universit{\"a}tsverlag Potsdam}, address = {Potsdam}, issn = {1866-8364}, doi = {10.25932/publishup-54957}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-549575}, pages = {1 -- 9}, year = {2021}, abstract = {Electrical muscle stimulation (EMS) is an increasingly popular training method and has become the focus of research in recent years. New EMS devices offer a wide range of mobile applications for whole-body EMS (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. The present study aimed to determine the differences in exercise intensity between WB-EMS-superimposed and conventional walking (EMS-CW), and CON and WB-EMS-superimposed Nordic walking (WB-EMS-NW) during a treadmill test. Eleven participants (52.0 ± years; 85.9 ± 7.4 kg, 182 ± 6 cm, BMI 25.9 ± 2.2 kg/m2) performed a 10 min treadmill test at a given velocity (6.5 km/h) in four different test situations, walking (W) and Nordic walking (NW) in both conventional and WB-EMS superimposed. Oxygen uptake in absolute (VO2) and relative to body weight (rel. VO2), lactate, and the rate of perceived exertion (RPE) were measured before and after the test. WB-EMS intensity was adjusted individually according to the feedback of the participant. The descriptive statistics were given in mean ± SD. For the statistical analyses, one-factorial ANOVA for repeated measures and two-factorial ANOVA [factors include EMS, W/NW, and factor combination (EMS*W/NW)] were performed (α = 0.05). Significant effects were found for EMS and W/NW factors for the outcome variables VO2 (EMS: p = 0.006, r = 0.736; W/NW: p < 0.001, r = 0.870), relative VO2 (EMS: p < 0.001, r = 0.850; W/NW: p < 0.001, r = 0.937), and lactate (EMS: p = 0.003, r = 0.771; w/NW: p = 0.003, r = 0.764) and both the factors produced higher results. However, the difference in VO2 and relative VO2 is within the range of biological variability of ± 12\%. The factor combination EMS*W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values (p = 0.035, r = 0.613), RPE differences for W/NW and EMS*W/NW were not significant. The current study results indicate that WB-EMS influences the parameters of exercise intensity. The impact on exercise intensity and the clinical relevance of WB-EMS-superimposed walking (WB-EMS-W) exercise is questionable because of the marginal differences in the outcome variables.}, language = {en} } @misc{BaritelloSalzwedelSuendermannetal.2021, author = {Baritello, Omar and Salzwedel, Annett and S{\"u}ndermann, Simon and Niebauer, Josef and V{\"o}ller, Heinz}, title = {The Pandora's Box of frailty assessments: Which is the best for clinical purposes in TAVI patients? A critical review}, series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, volume = {10}, journal = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, edition = {19}, publisher = {Universit{\"a}tsverlag Potsdam}, address = {Potsdam}, issn = {1866-8364}, doi = {10.25932/publishup-55044}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-550440}, pages = {1 -- 17}, year = {2021}, abstract = {Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95\% confidence interval (CI) 6.50-33.30) and lower serum albumin level (highest HR: 3.12; 95\% CI 1.80-5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95\% CI 2.71-86.10) and 1-year mortality (highest OR: 2.75; 95\% CI 1.55-4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty. View Full-Text}, language = {en} } @article{KatherHadzicHehleetal.2020, author = {Kather, Fritz and Hadzic, Miralem and Hehle, Teresa and Eichler, Sarah and Klein, Julia and V{\"o}ller, Heinz and Salzwedel, Annett}, title = {Test-retest reliability of the Mini Nutritional Assessment- Short Form (MNA-SF) in older patients undergoing cardiac rehabilitation}, series = {Journal of geriatric cardiology}, volume = {17}, journal = {Journal of geriatric cardiology}, number = {9}, publisher = {English China Online Journals, ECOJ}, address = {Windsor [u.a.]}, issn = {1671-5411}, doi = {10.11909/j.issn.1671-5411.2020.09.007}, pages = {574 -- 579}, year = {2020}, language = {en} } @misc{SchraplauBlockHaeusleretal.2021, author = {Schraplau, Anne and Block, Andrea and H{\"a}usler, Andreas and Wippert, Pia-Maria and Rapp, Michael Armin and V{\"o}ller, Heinz and Bonaventura, Klaus and Mayer, Frank}, title = {Mobile diagnostics and consultation for the prevention of the metabolic syndrome and its secondary diseases in Brandenburg—study protocol of a regional prospective cohort study: the Mobile Brandenburg Cohort}, series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, publisher = {Universit{\"a}tsverlag Potsdam}, address = {Potsdam}, issn = {1866-8364}, doi = {10.25932/publishup-54950}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-549506}, pages = {1 -- 11}, year = {2021}, abstract = {Background The metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a "Mobile Brandenburg Cohort" to reveal new causes and risk factors for MetS. Methods In a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis. Discussion The mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the "Mobile Brandenburg Cohort" create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions. Trial registration German Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered.}, language = {en} }