TY  - GEN
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
BT  - a systematic review and meta-analysis of randomized and non-randomized studies - the Cardiac Rehabilitation Outcome Study (CROS)
T2  - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
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.
T3  - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 418 
KW  - rehabilitation
KW  - acute coronary syndrome
KW  - coronary bypass grafting
KW  - coronary artery disease
KW  - mortality
KW  - hospital readmission
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-405346
IS  - 418
ER  - 
TY  - GEN
A1  - Vigorito, Carlo
A1  - Abreu, Ana
A1  - Ambrosetti, Marco
A1  - Belardinelli, Romualdo
A1  - Corrà, Ugo
A1  - Cupples, Margaret
A1  - Davos, Constantinos H.
A1  - Hoefer, Stefan
A1  - Iliou, Marie-Christine
A1  - Schmid, Jean-Paul
A1  - Völler, Heinz
A1  - Doherty, Patrick
T1  - Frailty and cardiac rehabilitation
BT  - a call to action from the EAPC Cardiac Rehabilitation Section
T2  - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
N2  - 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.
T3  - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 406 
KW  - frailty
KW  - cardiac rehabilitation
KW  - elderly
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-405172
IS  - 406
ER  -