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 - 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 - 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 - Ringwald, Juergen A1 - Lehmann, Marina A1 - Niemeyer, Nicole A1 - Seifert, Isabel A1 - Daubmann, Anne A1 - Wegscheider, Karl A1 - Salzwedel, Annett A1 - Luxembourg, Beate A1 - Eckstein, Reinhold A1 - Völler, Heinz T1 - Travel habits and complications in patients treated with vitamin K antagonists: A cross sectional analysis JF - Travel medicine and infectious disease N2 - Background: Travel-related conditions have impact on the quality of oral anticoagulation therapy (OAT) with vitamin K-antagonists. No predictors for travel activity and for travel-associated haemorrhage or thromboembolic complications of patients on OAT are known. Methods: A standardised questionnaire was sent to 2500 patients on long-term OAT in Austria, Switzerland and Germany. 997 questionnaires were received (responder rate 39.9%). Ordinal or logistic regression models with travel activity before and after onset of OAT or travel-associated haemorrhages and thromboembolic complications as outcome measures were applied. Results: 43.4% changed travel habits since onset of OAT with 24.9% and 18.5% reporting decreased or increased travel activity, respectively. Long-distance worldwide before OAT or having suffered from thromboembolic complications was associated with reduced travel activity. Increased travel activity was associated with more intensive travel experience, increased duration of OAT, higher education, or performing patient self-management (PSM). Travel-associated haemorrhages or thromboennbolic complications were reported by 6.5% and 0.9% of the patients, respectively. Former thromboennbolic complications, former bleedings and PSM were significant predictors of travel-associated complications. Conclusions: OAT also increases travel intensity. Specific medical advice prior travelling to prevent complications should be given especially to patients with former bleedings or thromboennbolic complications and to those performing PSM. (C) 2014 Elsevier Ltd. All rights reserved. KW - Vitamin k-antagonists KW - Oral anticoagulation KW - Travel KW - Patient self-management Y1 - 2014 U6 - https://doi.org/10.1016/j.tmaid.2014.02.006 SN - 1477-8939 SN - 1873-0442 VL - 12 IS - 3 SP - 258 EP - 263 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Dissmann, R. A1 - Cromme, L. J. A1 - Salzwedel, Annett A1 - Taborski, U. A1 - Kunath, J. A1 - Gaebler, F. A1 - Heyne, K. A1 - Völler, Heinz T1 - Computer aided dosage management of phenprocoumon anticoagulation therapy Clinical validation JF - Hämostaseologie : Organ der Gesellschaft für Thrombose- und Hämostaseforschung e.V. (GTH) N2 - A recently developed multiparameter computer-aided expert system (TheMa) for guiding anticoagulation with phenprocoumon (PPC) was validated by a prospective investigation in 22 patients. The PPC-INR-response curve resulting from physician guided dosage was compared to INR values calculated by "twin calculation" from TheMa recommended dosage. Additionally, TheMa was used to predict the optimal time to perform surgery or invasive procedures after interruption of anticogulation therapy. Results: Comparison of physician and TheMa guided anticoagulation showed almost identical accuracy by three quantitative measures: Polygon integration method (area around INR target) 616.17 vs. 607.86, INR hits in the target range 166 vs. 161, and TTR (time in therapeutic range) 63.91 vs. 62.40 %. After discontinuation of anticoagulation therapy, calculating the INR phase-out curve with TheMa INR prognosis of 1.8 was possible with a standard deviation of 0.50 +/- 0.59 days. Conclusion: Guiding anticoagulation with TheMa was as accurate as Physician guided therapy. After interruption of anticoagulant therapy, TheMa may be used for calculating the optimal time performing operations or initiating bridging therapy. KW - Oral anticoagulation therapy KW - warfarin KW - phenprocoumon KW - computer aided dosage KW - expert system Y1 - 2014 U6 - https://doi.org/10.5482/HAMO-13-06-0030 SN - 0720-9355 VL - 34 IS - 3 SP - 226 EP - 232 PB - Schattauer CY - Stuttgart ER - TY - GEN A1 - Völler, Heinz A1 - Salzwedel, Annett A1 - Nitardy, Aischa A1 - Buhlert, Hermann A1 - Treszl, Andra ́s A1 - Wegscheider, Karl T1 - Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 385 KW - Cardiac rehabilitation KW - emotional status KW - functional capacity KW - surgical aortic valve replacement (sAVR) KW - transcatheter aortic valve implantation (TAVI) Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-404100 IS - 385 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 - 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 -