TY - CHAP A1 - Nitardy, Aischa A1 - Salzwedel, Annett A1 - Wegscheider, Karl A1 - Jawari, Amir A1 - Buhlert, Hermann A1 - Völler, Heinz T1 - Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve replacement T2 - Circulation : an American Heart Association journal KW - Cardiac rehabilitation KW - TAVI KW - Transcatheter Aortic Valve Implantation KW - Aortic valve KW - Exercise tests Y1 - 2012 SN - 0009-7322 SN - 1524-4539 VL - 126 IS - 21 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Heneghan, Carl A1 - Ward, Alison A1 - Perera, Rafael A1 - Bankhead, Clare A1 - Fuller, Alice A1 - Stevens, Richard A1 - Bradford, Kairen A1 - Tyndel, Sally A1 - Alonso-Coello, Pablo A1 - Ansell, Jack A1 - Beyth, Rebecca A1 - Bernardo, Artur A1 - Christensen, Thomas Decker A1 - Cromheecke, Manon A1 - Edson, Robert G A1 - Fitzmaurice, David A1 - Gadisseur, Alain PA A1 - Garcia-Alamino, Josep M A1 - Gardiner, Chris A1 - Hasenkam, Michael A1 - Jacobson, Alan A1 - Kaatz, Scott A1 - Kamali, Farhad A1 - Khan, Tayyaba Irfan A1 - Knight, Eve A1 - Kortke, Heinrich A1 - Levi, Marcel A1 - Matchar, David Bruce A1 - Menendez-Jandula, Barbara A1 - Rakovac, Ivo A1 - Schaefer, Christian A1 - Siebenhofer, Andrea A1 - Souto, Juan Carlos A1 - Sunderji, Rubina A1 - Gin, Kenneth A1 - Shalansky, Karen A1 - Völler, Heinz A1 - Wagner, Otto A1 - Zittermann, Armin T1 - Self-monitoring of oral anticoagulation systematic review and meta-analysis of individual patient data JF - The lancet N2 - Background Uptake of self-testing and self-management of oral coagulation has remained inconsistent, despite good evidence of their effectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a meta-analysis of individual patient data addressing several important gaps in the evidence, including an estimate of the effect on time to death, first major haemorrhage, and thromboembolism. Methods We searched Ovid versions of Embase (1980-2009) and Medline (1966-2009), limiting searches to randomised trials with a maximally sensitive strategy. We approached all authors of included trials and requested individual patient data: primary outcomes were time to death, first major haemorrhage, and first thromboembolic event. We did prespecified subgroup analyses according to age, type of control-group care (anticoagulation-clinic care vs primary care), self-testing alone versus self-management, and sex. We analysed patients with mechanical heart valves or atrial fibrillation separately. We used a random-effect model method to calculate pooled hazard ratios and did tests for interaction and heterogeneity, and calculated a time-specific number needed to treat. Findings Of 1357 abstracts, we included 11 trials with data for 6417 participants and 12 800 person-years of follow-up. We reported a significant reduction in thromboembolic events in the self-monitoring group (hazard ratio 0.51; 95% CI 0.31-0.85) but not for major haemorrhagic events (0.88, 0.74-1.06) or death (0.82, 0.62-1.09). Participants younger than 55 years showed a striking reduction in thrombotic events (hazard ratio 0.33, 95% CI 0.17-0.66), as did participants with mechanical heart valve (0.52, 0.35-0.77). Analysis of major outcomes in the very elderly (age >= 85 years, n=99) showed no significant adverse effects of the intervention for all outcomes. Interpretation Our analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up. Y1 - 2012 U6 - https://doi.org/10.1016/S0140-6736(11)61294-4 SN - 0140-6736 VL - 379 IS - 9813 SP - 322 EP - 334 PB - Elsevier CY - New York ER - TY - JOUR A1 - Huber, Matthias A1 - Treszl, Andras A1 - Reibis, Rona Katharina A1 - Teichmann, Christopher A1 - Zergibel, Irina A1 - Bolbrinker, Juliane A1 - Scholze, Juergen A1 - Wegscheider, Karl A1 - Völler, Heinz A1 - Kreutz, Reinhold T1 - Genetics of melatonin receptor type 2 is associated with left ventricular function in hypertensive patients treated according to guidelines JF - European journal of internal medicine : official journal of the European Federation of Internal Medicine N2 - Background: Melatonin exerts multiple biological effects with potential impact on human diseases. This is underscored by genetic studies that demonstrated associations between melatonin receptor type 2 gene (MTNR1B) polymorphisms and characteristics of type 2 diabetes. We set out to test the hypothesis whether genetic variants at MTNR1B are also relevant for other disease phenotypes within the cardiovascular continuum. We thus investigated single nucleotide polymorphisms (SNPs) of MTNR1B in relation to blood pressure (BP) and cardiac parameters in hypertensive patients. Methods: Patients (n = 605, mean age 56.2 +/- 9.4 years, 82.3% male) with arterial hypertension and cardiac ejection fraction (EF) >= 40% were studied. Cardiac parameters were assessed by echocardiography. Results: The cohort comprised subjects with coronary heart disease (73.1%) and myocardial infarction (48.1%) with a mean EF of 63.7 +/- 8.9%. Analysis of SNPs rs10830962, rs4753426, rs12804291, rs10830963, and rs3781638 revealed two haplotypes 1 and 2 with frequencies of 0.402 and 0.277, respectively. Carriers with haplotype 1 (CTCCC) showed compared to non-carriers a higher mean 24-hour systolic BP (difference BP: 2.4 mm Hg, 95% confidence interval (CI): 0.3 to 4.5 mm Hg, p = 0.023). Haplotype 2 (GCCGA) was significantly related to EF with an absolute increase of 1.8% (CI: 0.45 to 3.14%) in carriers versus non-carriers (p = 0.009). Conclusion: Genetics of MTNR1B point to impact of the melatonin signalling pathway for BP and left ventricular function. This may support the importance of the melatonin system as a potential therapeutic target. KW - Clinical study KW - Genetics KW - Heart KW - Hypertension KW - Melatonin receptor type 2 Y1 - 2013 U6 - https://doi.org/10.1016/j.ejim.2013.03.015 SN - 0953-6205 VL - 24 IS - 7 SP - 650 EP - 655 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Gaede-Illig, Cathleen A1 - Limbourg, T. A1 - Jannowitz, Christina A1 - Völler, Heinz T1 - Predictors of exercise capacity improvement in patients after an acute coronary event during inpatient rehabilitation JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - 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. KW - kardiologische Rehabilitation KW - korperliche Leistungsfahigkeit KW - koronare Herzkrankheit KW - inpatient cardiac rehabilitation KW - exercise capacity KW - coronary artery disease Y1 - 2014 U6 - https://doi.org/10.1055/s-0034-1370983 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 5 SP - 341 EP - 345 PB - Thieme CY - Stuttgart ER - TY - CHAP A1 - Völler, Heinz A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Kaminski, S. A1 - Buhlert, Hermann A1 - Eichler, Sarah A1 - Wegscheider, Karl T1 - Age and fitness level are strongest limitations of exercise capacity during inpatient cardiac rehabilitation T2 - European heart journal Y1 - 2014 SN - 0195-668X SN - 1522-9645 VL - 35 SP - 899 EP - 899 PB - Oxford Univ. Press CY - Oxford 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 - 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 - Reibis, Rona Katharina A1 - Völler, Heinz A1 - Gitt, Anselm A1 - Jannowitz, Christina A1 - Halle, Martin A1 - Pittrow, David A1 - Hildemann, Steven T1 - Management of patients with ST- segment elevation or non- ST- segment elevation acute coronary syndromes in cardiac rehabilitation centers JF - Clinical cardiology : international journal for cardiovascular diseases N2 - 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. Y1 - 2014 U6 - https://doi.org/10.1002/clc.22241 SN - 0160-9289 SN - 1932-8737 VL - 37 IS - 4 SP - 213 EP - 221 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Mueller-Nordhorn, Jacqueline A1 - Muckelbauer, Rebecca A1 - Englert, Heike A1 - Grittner, Ulrike A1 - Berger, Hendrike A1 - Sonntag, Frank A1 - Völler, Heinz A1 - Prugger, Christof A1 - Wegscheider, Karl A1 - Katus, Hugo A. A1 - Willich, Stefan N. T1 - Longitudinal association between body mass index and health-related quality of life JF - PLoS one N2 - Objective: Health-related quality of life (HRQoL) is an important outcome in individuals with a high risk for cardiovascular diseases. We investigated the association of HRQoL and body mass index (BMI) as an indicator for obesity. Design: Secondary longitudinal analysis of the ORBITAL study, an intervention study which included high-risk cardiovascular primary care patients with hypercholesterolemia and an indication for statin therapy. Methods: HRQoL was determined with the generic Short Form (SF)-12 health status instrument. Body weight and height were assessed at baseline and at months 6, 12, 18, 24, 30, and 36. We used a linear and a linear mixed-effects regression model to investigate the association between BMI and SF-12 summary scores at baseline as well as between change in BMI and SF-12 summary scores over 3 years. We adjusted for age, sex, smoking status, and in the longitudinal analysis also for the study arm and its interaction term with time. Results: Of the 7640 participants who completed the baseline questionnaire, 6726 participants (mean age: 61 years) were analyzed. The baseline BMI was inversely associated with physical and mental SF-12 summary scores (beta [95% CI] per 1 kg/ m(2) : -0.36 [-0.41; -0.30] and -0.05 [-0.11; -0.00], respectively). A significant association between the change in BMI and physical SF-12 summary scores over time was only present in women (-0.18 [-0.27; -0.09]) and only in obese participants (-0.19 [-0.29; -0.10]). A change in BMI was directly associated with mental SF-12 summary scores (0.12 [0.06; 0.19]) in the total population. Conclusion: Increases in BMI were associated with decreases in physical HRQoL, particularly in obese individuals and in women. In contrast, the mental HRQoL seemed to increase with increasing BMI over time. Thus, body weight management with respect to the HRQoL should be evaluated differentially by sex and body weight status. Y1 - 2014 U6 - https://doi.org/10.1371/journal.pone.0093071 SN - 1932-6203 VL - 9 IS - 3 PB - PLoS CY - San Fransisco ER - TY - INPR A1 - Reibis, Rona Katharina A1 - Gaede-Illig, Cathleen A1 - Völler, Heinz T1 - Rehabilitation after Acute Myocardial Infarction T2 - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation Y1 - 2014 U6 - https://doi.org/10.1055/s-0034-1370119 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 3 SP - 191 EP - 201 PB - Thieme CY - Stuttgart ER -