TY - GEN A1 - Salzwedel, Annett A1 - Nosper, Manfred A1 - Röhrig, 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 T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 390 KW - cardiac rehabilitation KW - quality management KW - outcome measures Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-404151 IS - 390 ER - TY - JOUR A1 - Roehrig, B. A1 - Nosper, M. A1 - Linck-Eleftheriadis, S. A1 - Strandt, G. A1 - Salzwedel, Annett A1 - Völler, Heinz T1 - Method of the assessment of patients Outcome in cardiac rehabilitation by means of quality indicators - a description of the method JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - 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. KW - cardiac rehabilitation KW - quality indicator KW - outcome KW - success KW - quality management Y1 - 2014 U6 - https://doi.org/10.1055/s-0033-1341457 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 1 SP - 31 EP - 37 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Röhrig, Bernd A1 - Salzwedel, Annett A1 - Linck-Eleftheriadis, Sigrid A1 - Völler, Heinz A1 - Nosper, Manfred T1 - Outcome Based Center Comparisons in Inpatient Cardiac Rehabilitation Results from the EVA-Reha (R) Cardiology Project JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - 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. KW - outcome quality KW - quality assurance KW - cardiac rehabilitation KW - benchmark KW - profiling Y1 - 2015 U6 - https://doi.org/10.1055/s-0034-1395556 SN - 0034-3536 SN - 1439-1309 VL - 54 IS - 1 SP - 45 EP - 52 PB - Thieme CY - Stuttgart ER - TY - GEN 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 BT - the Reha-Sleep registry T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 400 KW - cardiac rehabilitation KW - sleep apnoea KW - sleep-disordered breathing Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-404814 IS - 400 ER - TY - GEN A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Haubold, Kathrin A1 - Schikora, Martin A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Jöbgens, Michael A1 - Völler, Heinz T1 - Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation N2 - 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 314 KW - cardiac rehabilitation KW - cognitive impairment KW - prevalence KW - acute coronary event KW - patient education Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-104113 SP - 55 EP - 60 ER - TY - JOUR A1 - Marx, R. A1 - Philips, H. A1 - Bassenge, D. A1 - Nosper, M. A1 - Roehrig, B. A1 - Linck-Eleftheriadis, S. A1 - Strandt, G. A1 - Salzwedel, Annett A1 - Pabst, F. T1 - Progress of Rehabilitation for Cardiac Patients Depending on the Degree of Self-Sufficiency at Admission JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Zusammenfassung Ziel der Studie: Es existieren kaum Publikationen uber das Rehabilitationsergebnis kardiologischer Patienten unter Berucksichtigung eines erhohten medizinischen, pflegerischen und therapeutischen Versorgungsaufwands (Barthel-Index70). Es war Ziel der Studie, die in einem Zeitraum von 2 Jahren aufgenommen Rehabilitanden (n=387) einer gesetzlichen Krankenkasse, aufgeteilt in jeweils eine Gruppe selbstversorgender und versorgungsaufwandiger Patienten, bezuglich ihrer Unterschiede in dem Rehabilitationsergebnis zu uberprufen. Methodik: In Abhangigkeit des Versorgungsaufwandes wurde das Rehabilitationsergebnis sowie Unterschiede im Verlauf hinsichtlich der korperlichen Leistungsfahigkeit, des emotionalen Status und der Aktivitaten des taglichen Lebens, gemessen an Barthelindex, FIM-Index, HADS-Werten, Komplikationen, Funktionsuntersuchungen, Belastungstests, Rehabilitationsdauer und Entlassungsform, gepruft. Ergebnisse: Die in Hinblick auf medizinischen, pflegerischen und therapeutischen Aufwand versorgungsaufwandigen Patienten waren alter, langer im Krankenhaus und in der Rehabilitation, sie hatten mehr Komplikationen und deutlich mehr Begleiterkrankungen. Sie wurden haufiger ins Akutkrankenhaus verlegt. Sie hatten eine hohere Steigerungsrate der Selbstversorgungsindices und eine relevante Steigerung bei den Belastungstests. Schlussfolgerung: Ein hoher Versorgungsaufwand multimorbider kardiologischer Patienten ist keine Kontraindikation gegen eine Rehabilitation, da auch bei dieser Patientengruppe die tragerspezifischen Rehabilitationsziele erreicht wurden. Abstract Introduction: There are hardly any publications about the outcome of cardiac rehabilitation considering patients with an increased need for medical, nursing and therapeutic care. The aim of this study, which consecutively included n=387 statutory health insurance inpatients over a period of 2 years, was to find out differences in outcome in self-care patients (Barthel index>70) as compared to patients with a need for complex care (Barthel index70). Methods: Rehabilitation outcomes concerning physical capacity, emotional status and activities of daily living as measured by Barthel index, FIM index, HADS, clinical complications, exercise test, duration of rehabilitation and form of dismission were analyzed and compared between both groups. Results: The inpatients with a Barthel index 70 at admission were older, had a longer stay in hospital and in rehabilitation, developed more complications and more often suffered from concomitant diseases. They were readmitted to hospital more often. They showed a comparatively higher increase in indices of self-care and a significant increase in physical performance tests. Conclusion: Higher medical care expenses of multimorbid cardiac inpatients are no contraindication against rehabilitation, because even in this group the specific rehabilitation aims of the healthcare payers can be reached. KW - kardiologische Rehabilitation KW - Rehabilitationspotenzial KW - Qualitatssicherung KW - Versorgungsaufwandig KW - Multimorbiditat KW - cardiac rehabilitation KW - rehabilitation potential KW - quality assurance KW - complex care KW - multimorbidity Y1 - 2016 U6 - https://doi.org/10.1055/s-0041-111524 SN - 0034-3536 SN - 1439-1309 VL - 55 SP - 34 EP - 39 PB - Thieme CY - Stuttgart ER - TY - GEN 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 T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe 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 (51.7 Æ 6.9 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 (VO 2peak ) were analysed using analysis of covariance (ANCOVA) models. Results: Mean training intensity was 90.7 Æ 9.7% of maximum heart rate (81% continuous/19% interval training, 64% additional strength training). A total of 12.2 Æ 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 Æ 623 watts  min). 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 VO 2peak 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 442 KW - cardiac rehabilitation KW - exercise tests KW - cardiorespiratory fitness KW - multivariate modelling Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-405302 IS - 442 ER - TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Haubold, Kathrin A1 - Schikora, Martin A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Jöbgens, Michael A1 - Völler, Heinz T1 - Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation JF - Vascular Health and Risk Management N2 - 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. KW - cardiac rehabilitation KW - cognitive impairment KW - prevalence KW - acute coronary event KW - patient education Y1 - 2017 U6 - https://doi.org/10.2147/VHRM.S121086 SN - 1176-6344 SN - 1178-2048 VL - 13 SP - 55 EP - 60 PB - Dove Medical Press Ltd CY - Albany, Auckland ER - TY - JOUR A1 - Schulz-Behrendt, Claudia A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Ortmann, K. A1 - Völler, Heinz T1 - Aspekte beruflicher und sozialer Wiedereingliederung aus Sicht kardiovaskulär erkrankter Rehabilitanden in besonderen beruflichen Problemlagen T1 - Subjective Aspects of Return to Work and Social Reintegration in Patients with Extensive Work-related Problems in Cardiac Rehabilitation BT - Ergebnisse einer qualitativen Erhebung BT - Results of a Qualitative Investigation JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Ziel: Untersucht wurden subjektive bio-psycho-soziale Auswirkungen chronischer Herz- und Gefäßerkrankungen, Bewältigungsstrategien und Formen sozialer Unterstützung bei Rehabilitanden in besonderen beruflichen Problemlagen (BBPL). Methodik: Für die qualitative Untersuchung wurden 17 Patienten (48,9±7,0 Jahre, 13 männl.) mit BBPL (SIMBO-C>30) in leitfadengestützten Interviews befragt. Die Auswertung erfolgte softwaregestützt nach dem inhaltsanalytischen Ansatz von Mayring. Ergebnisse: Im Rahmen der Krankheitsauswirkungen benannten die Patienten soziale, einschließlich beruflicher Aspekte mit 62% der Aussagen deutlich häufiger als physische oder psychische Faktoren (9 bzw. 29%). Angewandte Bewältigungsstrategien und erfahrene Unterstützungsleistungen richteten sich jedoch überwiegend auf körperliche Einschränkungen (70 bzw. 45%). Schlussfolgerung: Obgleich soziale Krankheitsauswirkungen für die befragten Rehabilitanden subjektiv bedeutsam waren, gelang die Entwicklung geeigneter Bewältigungsstrategien nur unzureichen N2 - Objective This study investigated subjective biopsychosocial effects of coronary heart disease (CHD), coping strategies and social support in patients undergoing cardiac rehabilitation (CR) and having extensive work-related problems. Methods A qualitative investigation was performed in 17 patients (48.9 +/- 7.0 y, 13 male) with extensive work-related problems (SIMBO-C > 30). All patients were interviewed with structured surveys. Data analysis was performed using a software that is based on the content analysis approach of Mayring. Results In regard to effects of disease, patients indicated social aspects including occupational aspects (62 %) more often than physical or mental factors (9 or 29 %). Applied coping strategies and support services are mainly focused on physical impairments (70 or 45 %). Conclusions The development of appropriate coping strategies was insufficient although social effects of disease were subjectively meaningful for patients in CR. KW - cardiac rehabilitation KW - extensive work-related problems KW - social support KW - return to work KW - kardiologische Rehabilitation KW - besondere berufliche Problemlagen KW - soziale Unterstützung KW - berufliche Wiedereingliederung Y1 - 2017 U6 - https://doi.org/10.1055/s-0042-121379 SN - 0034-3536 SN - 1439-1309 VL - 56 IS - 3 SP - 181 EP - 188 PB - Thieme CY - Stuttgart ER - TY - THES A1 - Eichler, Sarah T1 - Multidisziplinäre kardiologische Rehabilitation bei Patienten nach kathetergestützter Aortenklappenkorrektur T1 - Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation BT - Prädiktoren für die Veränderung der körperlichen Leistungsfähigkeit und Lebensqualität BT - predictors of functional and psychocognitive recovery N2 - Hintergrund Für Patienten mit hochgradiger Aortenklappenstenose, die aufgrund ihres Alters oder ihrer Multimorbidität ein hohes Operationsrisiko tragen, konnte mit der kathetergestützten Aortenklappenkorrektur (transcatheter aortic valve implantation, TAVI) eine vielversprechende Alternative zum herzchirurgischen Eingriff etabliert werden. Explizite Daten zur multidisziplinären kardiologischen Rehabilitation nach TAVI liegen bislang nicht vor. Ziel vorliegender Arbeit war, den Effekt der kardiologischen Rehabilitation auf die körperliche Leistungsfähigkeit, den emotionalen Status, die Lebensqualität und die Gebrechlichkeit bei Patienten nach TAVI zu untersuchen sowie Prädiktoren für die Veränderung der körperlichen Leistungsfähigkeit und der Lebensqualität zu identifizieren. Methodik Zwischen 10/2013 und 07/2015 wurden 136 Patienten (80,6 ± 5,0 Jahre, 47,8 % Männer) in Anschlussheilbehandlung nach TAVI in drei kardiologischen Rehabilitationskliniken eingeschlossen. Zur Beurteilung des Effekts der kardiologischen Rehabilitation wurden jeweils zu Beginn und Ende der Rehabilitation der Frailty (Gebrechlichkeits)-Index (Score bestehend aus Barthel-Index, Instrumental Activities of Daily Living, Mini Mental State Exam, Mini Nutritional Assessment, Timed Up and Go und subjektiver Mobilitätsverschlechterung), die Lebensqualität im Short-Form 12 (SF-12) sowie die funktionale körperliche Leistungsfähigkeit im 6-Minuten Gehtest (6-minute walk test, 6MWT) und die maximale körperliche Leistungsfähigkeit in der Belastungs-Ergometrie erhoben. Zusätzlich wurden soziodemographische Daten (z. B. Alter und Geschlecht), Komorbiditäten (z. B. chronisch obstruktive Lungenerkrankung, koronare Herzkrankheit und Karzinom), kardiovaskuläre Risikofaktoren und die NYHA-Klasse dokumentiert. Prädiktoren für die Veränderung der körperlichen Leistungsfähigkeit und Lebensqualität wurden mit Kovarianzanalysen angepasst. Ergebnisse Die maximale Gehstrecke im 6MWT konnte um 56,3 ± 65,3 m (p < 0,001) und die maximale körperliche Leistungsfähigkeit in der Belastungs-Ergometrie um 8,0 ± 14,9 Watt (p < 0001) gesteigert werden. Weiterhin konnte eine Verbesserung im SF-12 sowohl in der körperlichen Summenskala um 2,5 ± 8,7 Punkte (p = 0,001) als auch in der psychischen Summenskala um 3,4 ± 10,2 Punkte (p = 0,003) erreicht werden. In der multivariaten Analyse waren ein höheres Alter und eine höhere Bildung signifikant mit einer geringeren Zunahme im 6MWT assoziiert, währenddessen eine bessere kognitive Leistungsfähigkeit und Adipositas einen positiven prädiktiven Wert aufwiesen. Eine höhere Selbstständigkeit und ein besserer Ernährungsstatus beeinflussten die Veränderung in der körperlichen Summenskala des SF-12 positiv, währenddessen eine bessere kognitive Leistungsfähigkeit einen Prädiktor für eine geringere Veränderung darstellte. Des Weiteren hatten die jeweiligen Ausgangswerte der körperlichen und psychischen Summenskala im SF-12 einen inversen Einfluss auf die Veränderungen in der gleichen Skala. Schlussfolgerung Eine multidisziplinäre kardiologische Rehabilitation kann sowohl die körperliche Leistungs-fähigkeit und Lebensqualität verbessern als auch die Gebrechlichkeit von Patienten nach kathetergestützter Aortenklappenkorrektur verringern. Daraus resultierend gilt es, spezifische Assessments für die kardiologische Rehabilitation zu entwickeln. Weiterhin ist es notwendig, individualisierte Therapieprogramme mit besonderem Augenmerk auf kognitive Funktionen und Ernährung zu initiieren, um die Selbstständigkeit hochbetagter Patienten zu erhalten bzw. wiederherzustellen und um die Pflegebedürftigkeit der Patienten hinauszuzögern. N2 - Background In the last decade, transcatheter aortic valve implantation (TAVI) has reached widespread clinical acceptance as treatment for elderly and high-risk patients with aortic stenosis. Little is known about influencing factors of function and quality of life during multicomponent cardi-ac rehabilitation. The aim of the underlying study was to investigate the impact of a multidis-ciplinary inpatient cardiac rehabilitation on function and frailty as well as to find predictors for changes in quality of life and physical capacity. Methods From 10/2013 to 07/2015, patients with an elective TAVI and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. A Frailty-Index (a score including Activities of Daily Living, Instrumental Activities of Daily Living, Mini Men-tal State Exam, Mini Nutritional Assessment, Timed Up and Go und subjective mobility disa-bility), quality of life by Short Form-12 (SF-12), function by 6-minute walk distance (6MWD) and by maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. Additionally, sociodemographic parameters (e. g. age, sex), comorbidities (e. g. chronic obstructive pulmonary disease, coronary artery disease), cardiovascular risk factors and NYHA-class were documented. Predictors for changes in 6MWD and SF-12 were studied using analysis of covariance. Results 136 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 component scale 2.5 ± 8.7, p = 0.001, mental component scale 3.4 ± 10.2, p = 0.003) could be observed. In the multivariate analysis, age and a higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Nutrition and autonomy positively influenced the physical scale of SF-12, whereas a better cognitive performance negatively influenced it. 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 TAVI. This results in a reevaluation of diagnostic modalities, prognostic parameters and an individualised definition of achievable goals in the contemporary TAVI population during the recovery phase at cardiac rehabilitation. 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. KW - TAVI KW - Gebrechlichkeit KW - kardiologische Rehabilitation KW - Lebensqualität KW - körperliche Leistungsfähigkeit KW - TAVI KW - frailty KW - cardiac rehabilitation KW - quality of life KW - exercise capacity Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-406618 ER -