TY  - JOUR
A1  - Rauch, Bernhard
A1  - Davos, Constantinos H.
A1  - Doherty, Patrick
A1  - Saure, Daniel
A1  - Metzendorf, Maria-Inti
A1  - Salzwedel, Annett
A1  - Völler, Heinz
A1  - Jensen, Katrin
A1  - Schmid, Jean-Paul
T1  - 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)
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Rehabilitation
KW  - acute coronary syndrome
KW  - coronary bypass grafting
KW  - coronary artery disease
KW  - mortality
KW  - hospital readmission
Y1  - 2016
U6  - https://doi.org/10.1177/2047487316671181
SN  - 2047-4873
SN  - 2047-4881
VL  - 23
SP  - 1914
EP  - 1939
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Reibis, Rona Katharina
A1  - Heidler, Maria-Dorothea
A1  - Wegscheider, Karl
A1  - Völler, Heinz
T1  - Determinants of Return to Work After Multicomponent Cardiac Rehabilitation
JF  - Archives of Physical Medicine and Rehabilitation
N2  - 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.
KW  - Acute coronary syndrome
KW  - Cardiac rehabilitation
KW  - Coronary artery bypass grafting
KW  - Motivation
KW  - Rehabilitation
KW  - Return to work
Y1  - 2019
U6  - https://doi.org/10.1016/j.apmr.2019.04.003
SN  - 0003-9993
SN  - 1532-821X
VL  - 100
IS  - 12
SP  - 2399
EP  - 2402
PB  - Elsevier
CY  - Philadelphia
ER  -