TY  - JOUR
A1  - Zoch-Lesniak, Beate
A1  - Dobberke, Jeanette
A1  - Schlitt, Axel
A1  - Bongarth, Christa
A1  - Glatz, Johannes
A1  - Spörl-Dönch, Sieglinde
A1  - Koran, Iryna
A1  - Völler, Heinz
A1  - Salzwedel, Annett
T1  - Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age
BT  - Results of the Prospective Observational Multicenter Registry OutCaRe
JF  - Archives of Rehabilitation Research and Clinical Translation
N2  - 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.
KW  - Cardiac rehabilitation
KW  - Outcome measures
KW  - Cardiovascular diseases
Y1  - 2019
U6  - https://doi.org/10.1016/j.arrct.2020.100043
SN  - 2590-1095
VL  - 2
PB  - Elsevier
CY  - Amsterdam
ER  - 
TY  - JOUR
A1  - Völler, Heinz
A1  - Salzwedel, Annett
A1  - Nitardy, Aischa
A1  - Buhlert, Hermann
A1  - Treszl, Andras
A1  - Wegscheider, Karl
T1  - Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Cardiac rehabilitation
KW  - emotional status
KW  - functional capacity
KW  - surgical aortic valve replacement (sAVR)
KW  - transcatheter aortic valve implantation (TAVI)
Y1  - 2015
U6  - https://doi.org/10.1177/2047487314526072
SN  - 2047-4873
SN  - 2047-4881
VL  - 22
IS  - 5
SP  - 568
EP  - 574
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Völler, Heinz
A1  - Gitt, Anselm
A1  - Jannowitz, Christina
A1  - Karoff, Marthin
A1  - Karmann, Barbara
A1  - Pittrow, David
A1  - Reibis, Rona Katharina
A1  - Hildemann, Steven
T1  - Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Cardiac rehabilitation
KW  - registry
KW  - chronic kidney disease
KW  - glomerular filtration rate
KW  - dyslipidemia
KW  - control rates
KW  - risk factor
KW  - lipids
Y1  - 2014
U6  - https://doi.org/10.1177/2047487313482285
SN  - 2047-4873
SN  - 2047-4881
VL  - 21
IS  - 9
SP  - 1125
EP  - 1133
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Skobel, Erik
A1  - Kamke, Wolfram
A1  - Bönner, Gerd
A1  - Alt, Bernd
A1  - Purucker, Hans-Christian
A1  - Schwaab, Bernhard
A1  - Einwang, Hans-Peter
A1  - Schröder, Klaus
A1  - Langheim, Eike
A1  - Völler, Heinz
A1  - Brandenburg, Alexandra
A1  - Graml, Andrea
A1  - Woehrle, Holger
A1  - Krüger, Stefan
T1  - Risk factors for, and prevalence of, sleep apnoea in cardiac rehabilitation facilities in Germany: The Reha-Sleep registry
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Cardiac rehabilitation
KW  - sleep apnoea
KW  - sleep-disordered breathing
Y1  - 2015
U6  - https://doi.org/10.1177/2047487314537916
SN  - 2047-4873
SN  - 2047-4881
VL  - 22
IS  - 7
SP  - 820
EP  - 830
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Wegscheider, Karl
A1  - Schulz-Behrendt, Claudia
A1  - Dörr, Gesine
A1  - Reibis, Rona Katharina
A1  - Völler, Heinz
T1  - 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
JF  - International archives of occupational and environmental health
N2  - 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.
KW  - Social work
KW  - Cardiac rehabilitation
KW  - Return to work
KW  - Quality of life
KW  - Acute coronary syndrome
KW  - RCT
Y1  - 2019
U6  - https://doi.org/10.1007/s00420-019-01450-3
SN  - 0340-0131
SN  - 1432-1246
VL  - 92
IS  - 8
SP  - 1109
EP  - 1120
PB  - Springer
CY  - New York
ER  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Wegscheider, Karl
A1  - Herich, Lena
A1  - Rieck, Angelika
A1  - Strandt, Gert
A1  - Völler, Heinz
T1  - Impact of clinical and sociodemographic patient characteristics on the outcome of cardiac rehabilitation in older patients
JF  - Aging clinical and experimental research
N2  - 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.
KW  - Cardiac rehabilitation
KW  - Composite outcome measure
KW  - Predictors
KW  - Rehabilitation success
KW  - Older patients
Y1  - 2015
U6  - https://doi.org/10.1007/s40520-014-0283-2
SN  - 1594-0667
SN  - 1720-8319
VL  - 27
IS  - 3
SP  - 315
EP  - 321
PB  - Springer
CY  - New York
ER  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Reibis, Rona Katharina
A1  - Wegscheider, Karl
A1  - Eichler, Sarah
A1  - Buhlert, Hermann
A1  - Kaminski, Stefan
A1  - Völler, Heinz
T1  - Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation
JF  - Clinical research in cardiology : official journal of the German Cardiac Society.
N2  - 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).
KW  - Cardiac rehabilitation
KW  - Prognosis
KW  - Exercise capacity
KW  - Coronary disease
KW  - Social medicine
Y1  - 2016
U6  - https://doi.org/10.1007/s00392-015-0917-1
SN  - 1861-0684
SN  - 1861-0692
VL  - 105
SP  - 257
EP  - 267
PB  - Springer
CY  - Heidelberg
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  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Nosper, Manfred
A1  - Roehrig, Bernd
A1  - Linck-Eleftheriadis, Sigrid
A1  - Strandt, Gert
A1  - Völler, Heinz
T1  - Outcome quality of in-patient cardiac rehabilitation in elderly patients - identification of relevant parameters
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Cardiac rehabilitation
KW  - quality management
KW  - outcome measures
Y1  - 2014
U6  - https://doi.org/10.1177/2047487312469475
SN  - 2047-4873
SN  - 2047-4881
VL  - 21
IS  - 2
SP  - 172
EP  - 180
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Reibis, Rona Katharina
A1  - Salzwedel, Annett
A1  - Buhlert, Hermann
A1  - Wegscheider, Karl
A1  - Eichler, Sarah
A1  - Völler, Heinz
T1  - Impact of training methods and patient characteristics on exercise capacity in patients in cardiovascular rehabilitation
JF  - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology
N2  - 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.
KW  - Cardiac rehabilitation
KW  - exercise tests
KW  - cardiorespiratory fitness
KW  - multivariate modelling
Y1  - 2016
U6  - https://doi.org/10.1177/2047487315600815
SN  - 2047-4873
SN  - 2047-4881
VL  - 23
SP  - 452
EP  - 459
PB  - Sage Publ.
CY  - London
ER  -