39199
2015
2015
eng
211
219
9
2
31
article
Taylor & Francis Group
London
1
--
--
--
Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers
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.
Current medical research and opinion
10.1185/03007995.2014.977854
25325219
0300-7995
1473-4877
wos:2015
WOS:000349979800003
Voller, H (reprint author), Univ Potsdam, Neuen Palais 10,Haus 12, D-14469 Potsdam, Germany., heinz.voeller@uni-potsdam.de
Merck Sharp & Dohme (MSD) GmbH, Munich-Haar, Germany
Rona Katharina Reibis
Christina Jannowitz
Martin Halle
David Pittrow
Anselm Gitt
Heinz Völler
eng
uncontrolled
Acute myocardial infarction
eng
uncontrolled
Cardiac rehabilitation Chronic heart failure
eng
uncontrolled
Control rates
eng
uncontrolled
Dyslipidemia
eng
uncontrolled
Lipid profile
eng
uncontrolled
Observational
eng
uncontrolled
Risk factor
Referiert
Department Sport- und Gesundheitswissenschaften
Institut für Sportwissenschaft
37963
2014
2014
eng
213
221
9
4
37
article
Wiley-Blackwell
Hoboken
1
--
--
--
Management of patients with ST- segment elevation or non- ST- segment elevation acute coronary syndromes in cardiac rehabilitation centers
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.
Clinical cardiology : international journal for cardiovascular diseases
10.1002/clc.22241
24847509
0160-9289
1932-8737
wos:2014
WOS:000334331600003
Voller, H (reprint author), Univ Potsdam, Neuen Palais 10,Haus 12, D-14469 Potsdam, Germany., heinz.voeller@uni-potsdam.de
MSD Sharp Dohme GmbH; Munich-Haar, Germany
Rona Katharina Reibis
Heinz Völler
Anselm Gitt
Christina Jannowitz
Martin Halle
David Pittrow
Steven Hildemann
Institut für Physik und Astronomie
Referiert
Department Sport- und Gesundheitswissenschaften
Institut für Sportmedizin und Prävention
37507
2014
2014
eng
341
345
5
5
53
article
Thieme
Stuttgart
1
--
--
--
Predictors of exercise capacity improvement in patients after an acute coronary event during inpatient rehabilitation
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.
Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation
10.1055/s-0034-1370983
25317898
0034-3536
1439-1309
wos:2014
WOS:000344051800009
Voller, H (reprint author), Univ Potsdam, Humanwissensch Fak, Neuen Palais 10, D-14469 Potsdam, Germany., heinz.voeller@uni-potsdam.de
Cathleen Gaede-Illig
T. Limbourg
Christina Jannowitz
Heinz Völler
eng
uncontrolled
kardiologische Rehabilitation
eng
uncontrolled
korperliche Leistungsfahigkeit
eng
uncontrolled
koronare Herzkrankheit
eng
uncontrolled
inpatient cardiac rehabilitation
eng
uncontrolled
exercise capacity
eng
uncontrolled
coronary artery disease
Referiert
Department Sport- und Gesundheitswissenschaften
Institut für Sportmedizin und Prävention
37605
2014
2014
eng
1125
1133
9
9
21
article
Sage Publ.
London
1
--
--
--
Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting
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.
European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
10.1177/2047487313482285
23508927
2047-4873
2047-4881
wos:2014
WOS:000340729300008
Voller, H (reprint author), Univ Potsdam, Neuen Palais 10,Haus 12, D-14469 Potsdam, Germany., heinz.voeller@uni-potsdam.de
MSD Sharp & Dohme GmbH, Munich-Haar, Germany; MSD
<a href="http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-40406">Zweitveröffentlichung in der Schriftenreihe Postprints der Universität Potsdam : Humanwissenschaftliche Reihe ; 381</a>
Heinz Völler
Anselm Gitt
Christina Jannowitz
Marthin Karoff
Barbara Karmann
David Pittrow
Rona Katharina Reibis
Steven Hildemann
eng
uncontrolled
Cardiac rehabilitation
eng
uncontrolled
registry
eng
uncontrolled
chronic kidney disease
eng
uncontrolled
glomerular filtration rate
eng
uncontrolled
dyslipidemia
eng
uncontrolled
control rates
eng
uncontrolled
risk factor
eng
uncontrolled
lipids
Strukturbereich Kognitionswissenschaften
Referiert
Exzellenzbereich Kognitionswissenschaften
40406
2014
2018
eng
9
381
postprint
1
2018-03-27
2018-03-27
--
Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting
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.
Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
urn:nbn:de:kobv:517-opus4-404065
online registration
European Journal of Preventive Cardiology (2014), Nr. 21(9), S.1125-1133 DOI 10.1177/2047487313482285
<a href="http://publishup.uni-potsdam.de/opus4-ubp/frontdoor/index/index/docId/37605">Bibliographieeintrag der Originalveröffentlichung/Quelle</a>
Keine öffentliche Lizenz: Unter Urheberrechtsschutz
Heinz Völler
Anselm Gitt
Christina Jannowitz
Marthin Karoff
Barbara Karmann
David Pittrow
Rona Katharina Reibis
Steven Hildemann
Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
381
eng
uncontrolled
Cardiac rehabilitation
eng
uncontrolled
registry
eng
uncontrolled
chronic kidney disease
eng
uncontrolled
glomerular filtration rate
eng
uncontrolled
dyslipidemia
eng
uncontrolled
control rates
eng
uncontrolled
risk factor
eng
uncontrolled
lipids
Technik, Medizin, angewandte Wissenschaften
Medizin und Gesundheit
Medizin und Gesundheit
open_access
Humanwissenschaftliche Fakultät
Referiert
Open Access
Sage
Universität Potsdam
https://publishup.uni-potsdam.de/files/40406/phr381.online.pdf