TY - JOUR A1 - Reibis, Rona Katharina A1 - Schlitt, A. A1 - Glatz, J. A1 - Langheim, E. H. A1 - Guha, M. A1 - Halle, M. A1 - Boscheri, A. A1 - Hegeler-Molkewehrum, C. A1 - Völler, Heinz T1 - Rehabilitation in Heart Failure JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Kernaussagen: - Patienten mit Herzinsuffizienz (HF-rEF, HF-pEF oder in Kombination) stellen einen relevanten Anteil von Patienten in kardiologischen Rehabilitationseinrichtungen dar. Sie erfordern aufgrund der eingeschränkten Ventrikelfunktion, der Arrhythmieneigung sowie den häufig implantierten elektrischen Aggregaten ein multimodales Therapiekonzept. - Neben der leitlinienorientierten Pharmakotherapie nehmen die individualisierte Trainingstherapie und die psychosoziale Betreuung tragende Funktionen in der Rehabilitation herzinsuffizienter Patienten ein. - Die berufliche Wiedereingliederung wird durch die hämodynamische Stabilität, die kognitiven Leistungen, die Arbeitsplatzanforderungen und Arbeitsplatzsicherheit insbesondere bei ICD/CRT-Trägern determiniert. - Die Fahreignung wird überwiegend in Einzelfallentscheidungen bestimmt und richtet sich u. a. nach der linksventrikulären Pumpleistung und dem arrhythmiefreien Intervall. Y1 - 2016 U6 - https://doi.org/10.1055/s-0042-103302 SN - 0034-3536 SN - 1439-1309 VL - 55 SP - 115 EP - 129 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Piepoli, Massimo F. A1 - Corra, Ugo A1 - Abreu, Ana A1 - Cupples, Margaret A1 - Davos, Costantinos A1 - Doherty, Patrick A1 - Hoefer, Stephan A1 - Garcia-Porrero, Esteban A1 - Rauchi, Bernhard A1 - Vigorito, Carlo A1 - Völler, Heinz A1 - Schmid, Jean-Paul T1 - Challenges in secondary prevention of cardiovascular diseases A review of the current practice JF - International journal of cardiology N2 - With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care. (C) 2014 Elsevier Ireland Ltd. All rights reserved. KW - Cardiac rehabilitation KW - Cardiovascular risk factor KW - Long term management KW - Secondary prevention Y1 - 2015 U6 - https://doi.org/10.1016/j.ijcard.2014.11.107 SN - 0167-5273 SN - 1874-1754 VL - 180 SP - 114 EP - 119 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Reibis, Rona Katharina A1 - Huber, Matthias A1 - Karoff, Marthin A1 - Kamke, Wolfram A1 - Kreutz, Reinhold A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Target organ damage and control of cardiovascular risk factors in hypertensive patients Evidence from the multicenter ESTher registry JF - Herz : cardiovascular diseases N2 - This study investigated the incidence of hypertensive target organ damage (TOD), control of cardiovascular risk factors, and the short-term prognosis in hypertensive patients under contemporary guideline-oriented therapy. A total of 1,377 consecutive patients (mean age 58.2 +/- 9.9 years, 82.2 % male) with arterial hypertension were included in the ESTher (Endorganschaden, Therapie und Verlauf - target organ damage, therapy, and course) registry at 15 rehabilitation clinics within the framework of the National Genome Research Network. Cardiovascular risk factors, medication, comorbidities, and glomerular filtration rate (GFR) were assessed. Left ventricular hypertrophy (LVH), left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were determined by two-dimensional echocardiography. The mean follow-up was 513 +/- 159 days. Changes in continuous parameters were tested by the t test, changes in discrete characteristics are presented by means of transition tables and tested with the McNemar test. The mean LVEF was 59.3 +/- 9.9 %, both mean LVM (238.6 +/- 101.5 g) and LVMI (54.0 +/- 23.6 g/m(2.7)) were increased while relative wall thickness (RWT, 0.46 +/- 0.18) indicated the presence of concentric LVH. Of the patients, 10.2 % displayed renal dysfunction (estimated GFR < 60 ml/min/1.73 m(2)). The 1.5-year overall mortality was 1.2 %. Compared with discharge, at follow-up the proportion of patients with blood pressure (BP) values < 140/90 mmHg decreased from 68.7 % to 55.0 % (p < 0.001) and with low-density lipoprotein (LDL) values < 100 mg/dl from 62.6 % to 38.1 % (p < 0.001). At follow-up significantly more patients displayed a GFR value of < 60 ml/min/1.73 m(2) (10.2 % vs. 16.0 %, p < 0.001). A significant proportion of hypertensive rehabilitation participants displayed TOD including LVH and renal dysfunction. Even after stringent BP reduction, a considerable increase in nephropathy could be found after 18 months. KW - Arterial hypertension KW - Prospective study KW - Left ventricular hypertrophy KW - Glomerular filtration rate KW - Cardiac rehabilitation Y1 - 2015 U6 - https://doi.org/10.1007/s00059-014-4189-8 SN - 0340-9937 SN - 1615-6692 VL - 40 SP - 209 EP - 216 PB - Urban & Vogel CY - München 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 - JOUR A1 - Reibis, Rona Katharina A1 - Jannowitz, Christina A1 - Halle, Martin A1 - Pittrow, David A1 - Gitt, Anselm A1 - Völler, Heinz T1 - Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers JF - Current medical research and opinion N2 - Background: We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events. Methods: Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7%) who underwent an inpatient CR period of about 3 weeks in 2009-2010. Results: Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p<0.0001), and more often had risk factors such as diabetes mellitus (39.7% vs. 32.0%, p<0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4%), and reduced in patients with low EF compared to those with normal EF (47.7% vs. 55.5%, p<0.0001). The rate of patients that achieved lower LDL cholesterol (5100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p<0.0001) and at discharge (119/72 vs. 124/74 mmHg, p<0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p<0.0001; at discharge 85 vs. 105 Watts, p<0.0001). Event rates during CR were low, and only 0.3% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay. Conclusions: Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved. KW - Acute myocardial infarction KW - Cardiac rehabilitation Chronic heart failure KW - Control rates KW - Dyslipidemia KW - Lipid profile KW - Observational KW - Risk factor Y1 - 2015 U6 - https://doi.org/10.1185/03007995.2014.977854 SN - 0300-7995 SN - 1473-4877 VL - 31 IS - 2 SP - 211 EP - 219 PB - Taylor & Francis Group CY - London ER - TY - JOUR A1 - Heidler, Maria-Dorothea A1 - Bidu, Laura A1 - Friedrich, Nele A1 - Völler, Heinz T1 - Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia JF - Medizinische Klinik, Intensivmedizin und Notfallmedizin N2 - In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration. KW - Intubation KW - Tracheotomy KW - Ventilation KW - Endoscopy KW - Respiratory aspiration Y1 - 2015 U6 - https://doi.org/10.1007/s00063-014-0397-5 SN - 2193-6218 VL - 110 IS - 1 SP - 55 EP - 60 PB - Springer CY - New York ER - TY - JOUR A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Zahn, Thomas A1 - Neuwirth, Julia A1 - Eichler, Sarah A1 - Haubold, Kathrin A1 - Wachholz, Anne A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - User Interest in Digital Health Technologies to Encourage Physical Activity BT - Results of a Survey in Students and Staff of a German University JF - JMIR. Mhealth & Uhealth N2 - Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. KW - physical activity KW - telemedicine KW - primary prevention KW - healthy lifestyle Y1 - 2017 U6 - https://doi.org/10.2196/mhealth.7192 VL - 5 IS - 4 PB - JMIR Publications CY - Toronto ER - TY - GEN A1 - Salzwedel, Annett A1 - Rabe, Sophie A1 - Zahn, Thomas A1 - Neuwirth, Julia A1 - Eichler, Sarah A1 - Haubold, Kathrin A1 - Wachholz, Anne A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - User Interest in Digital Health Technologies to Encourage Physical Activity BT - Results of a Survey in Students and Staff of a German University N2 - Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 342 KW - healthy lifestyle KW - physical activity KW - primary prevention KW - telemedicine Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-401872 ER - TY - GEN 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 T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 381 KW - Cardiac rehabilitation KW - registry KW - chronic kidney disease KW - glomerular filtration rate KW - dyslipidemia KW - control rates KW - risk factor KW - lipids Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-404065 IS - 381 ER - TY - GEN A1 - Huber, Matthias A1 - Lezius, Susanne A1 - Reibis, Rona Katharina A1 - Treszl, Andras A1 - Kujawinska, Dorota A1 - Jakob, Stefanie A1 - Wegscheider, Karl A1 - Völler, Heinz A1 - Kreutz, Reinhold T1 - A single nucleotide polymorphism near the CYP17A1 gene is associated with left ventricular mass in hypertensive patients under pharmacotherapy N2 - Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% ± 9.3%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%–12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 333 KW - clinical study KW - genetics KW - heart KW - hypertension KW - cytochrome P450 17A1 (Cyp17A1) Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-400074 ER - TY - JOUR A1 - Vigorito, Carlo A1 - Abreu, Ana A1 - Ambrosetti, Marco A1 - Belardinelli, Romualdo A1 - Corra, 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: A call to action from the EAPC Cardiac Rehabilitation Section JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology 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. KW - Frailty KW - cardiac rehabilitation KW - elderly Y1 - 2017 U6 - https://doi.org/10.1177/2047487316682579 SN - 2047-4873 SN - 2047-4881 VL - 24 SP - 577 EP - 590 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Hansen, Dominique A1 - Dendale, Paul A1 - Coninx, Karin A1 - Vanhees, Luc A1 - Piepoli, Massimo F. A1 - Niebauer, Josef A1 - Cornelissen, Veronique A1 - Pedretti, Roberto A1 - Geurts, Eva A1 - Ruiz, Gustavo R. A1 - Corra, Ugo A1 - Schmid, Jean-Paul A1 - Greco, Eugenio A1 - Davos, Constantinos H. A1 - Edelmann, Frank A1 - Abreu, Ana A1 - Rauch, Bernhard A1 - Ambrosetti, Marco A1 - Braga, Simona S. A1 - Barna, Olga A1 - Beckers, Paul A1 - Bussotti, Maurizio A1 - Fagard, Robert A1 - Faggiano, Pompilio A1 - Garcia-Porrero, Esteban A1 - Kouidi, Evangelia A1 - Lamotte, Michel A1 - Neunhaeuserer, Daniel A1 - Reibis, Rona Katharina A1 - Spruit, Martijn A. A1 - Stettler, Christoph A1 - Takken, Tim A1 - Tonoli, Cajsa A1 - Vigorito, Carlo A1 - Völler, Heinz A1 - Doherty, Patrick T1 - The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases. KW - Cardiovascular disease KW - rehabilitation KW - exercise training KW - training and decision support system Y1 - 2017 U6 - https://doi.org/10.1177/2047487317702042 SN - 2047-4873 SN - 2047-4881 VL - 24 SP - 1017 EP - 1031 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Kiefer, Thomas A1 - Krahl, Dorothea A1 - Hirt, Carsten A1 - Völler, Heinz A1 - Voelkel, Lorenz A1 - Daeschlein, Georg T1 - Influence of treatment caused impairments on anxiety and depression in patients with cancer of the Esophagus or the Esophagogastric junction JF - Journal of gastrointestinal cancer N2 - Purpose After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated. Method Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed. Results We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0-13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0-15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety. Conclusions Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression. KW - Anxiety KW - Depression KW - Esophagus carcinoma KW - Exocrine pancreas KW - insufficiency KW - Rehabilitation KW - Steatorrhea Y1 - 2019 U6 - https://doi.org/10.1007/s12029-018-00193-7 SN - 1941-6628 SN - 1941-6636 VL - 51 IS - 1 SP - 30 EP - 34 PB - Springer CY - New York ER - TY - JOUR A1 - Fayyaz, Susann A1 - Japtok, Lukasz A1 - Schumacher, Fabian A1 - Wigger, Dominik A1 - Schulz, Tim Julius A1 - Haubold, Kathrin A1 - Gulbins, Erich A1 - Völler, Heinz A1 - Kleuser, Burkhard T1 - Lysophosphatidic acid inhibits insulin signaling in primary rat hepatocytes via the LPA(3) receptor subtype and is increased in obesity JF - Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry and pharmacology N2 - Background/Aims: Obesity is a main risk factor for the development of hepatic insulin resistance and it is accompanied by adipocyte hypertrophy and an elevated expression of different adipokines such as autotaxin (ATX). ATX converts lysophosphatidylcholine to lysophosphatidic acid (LPA) and acts as the main producer of extracellular LPA. This bioactive lipid regulates a broad range of physiological and pathological responses by activation of LPA receptors (LPA1-6). Methods: The activation of phosphatidylinositide 3-kinases (PI3K) signaling (Akt and GSK-3ß) was analyzed via western blotting in primary rat hepatocytes. Incorporation of glucose into glycogen was measured by using radio labeled glucose. Real-time PCR analysis and pharmacological modulation of LPA receptors were performed. Human plasma LPA levels of obese (BMI > 30, n = 18) and normal weight individuals (BMI 18.5-25, n = 14) were analyzed by liquid chromatography tandem-mass spectrometry (LC-MS/MS). Results: Pretreatment of primary hepatocytes with LPA resulted in an inhibition of insulin-mediated Gck expression, PI3K activation and glycogen synthesis. Pharmacological approaches revealed that the LPA3-receptor subtype is responsible for the inhibitory effect of LPA on insulin signaling. Moreover, human plasma LPA concentrations (16: 0 LPA) of obese participants (BMI > 30) are significantly elevated in comparison to normal weight individuals (BMI 18.5-25). Conclusion: LPA is able to interrupt insulin signaling in primary rat hepatocytes via the LPA3 receptor subtype. Moreover, the bioactive lipid LPA (16: 0) is increased in obesity. KW - Lysophosphatidic acid KW - Insulin signaling KW - Adipose tissue KW - Autotaxin KW - Hepatic insulin resistance KW - LPA(3) receptor subtype Y1 - 2017 U6 - https://doi.org/10.1159/000480470 SN - 1015-8987 SN - 1421-9778 VL - 43 SP - 445 EP - 456 PB - Karger CY - Basel ER - TY - JOUR A1 - Völler, Heinz A1 - Schwaab, Bernhard T1 - Kardiologische Rehabilitation JF - Der Kardiologe : die Fortbildungszeitschrift der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung N2 - Hintergrund Eine Verlängerung der Lebens- und Arbeitszeit erfordert einen aktiven Lebensstil, eine Optimierung von kardiovaskulären Risikofaktoren und psychosoziale Unterstützung chronisch Herzkranker. Fragestellung Können die Prognose und Lebensqualität sowie die soziale oder berufliche Teilhabe kardiovaskulär Erkrankter durch kardiologische Rehabilitation (KardReha) verbessert werden? Material und Methode Auf der Grundlage neuer Metaanalysen und aktueller Positionspapiere gibt die S3-Leitlinie zur kardiologischen Rehabilitation evidenzbasierte Empfehlungen. Ergebnisse Eine KardReha reduziert bei Patienten nach akutem Koronarsyndrom, nach PCI („percutaneous coronary interventions“) oder nach aortokoronarer Koronarbypassoperation (ACB-Op.) sowie nach Klappenkorrektur die Gesamtsterblichkeit. Bei Patienten mit systolischer Herzinsuffizienz (HFrEF [„heart failure with reduced ejection fraction“]) werden Belastbarkeit und Lebensqualität durch eine KardReha verbessert. Psychosozialer Distress kann verringert und die berufliche Wiedereingliederung besser strukturiert werden. Schlussfolgerung Im Jahr 2019 liegen aktuelle, evidenzbasierte Leitlinien vor, die aufgrund verbesserter Prognose, Belastbarkeit und Lebensqualität eine multimodale kardiologische Rehabilitation bei Patienten nach akutem kardialem Ereignis auch bei technischem Fortschritt (z. B. katheterbasierter Klappenkorrektur) und unter Aspekten der sozialen und beruflichen Teilhabe empfehlen. N2 - Background Prolonging the life span and working life requires an active lifestyle, optimization of cardiovascular risk factors and psychosocial support for patients suffering from chronic heart disease. Objective Is it possible to improve the prognosis and quality of life as well as social and occupational participation of patients with cardiovascular diseases by cardiac rehabilitation? Material and methods The S3 guidelines on cardiac rehabilitation in German-speaking countries provide evidence-based recommendations based on recent meta-analyses and current position papers. Results Cardiac rehabilitation is able to reduce overall mortality in patients with acute coronary syndrome, after percutaneous coronary interventions or surgical revascularization as well as after heart valve correction. In patients with systolic heart failure (heart failure with reduced ejection fraction, HFrEF) exercise capacity and quality of life are improved by cardiac rehabilitation. Psychosocial distress can be reduced and occupational reintegration can be adequately planned. Conclusion In 2019 current evidence-based guidelines are available that recommend a multimodal cardiac rehabilitation in patients after an acute cardiac event, due to improvement of prognosis, exercise capacity and quality of life as well as due to technical progress (e.g. catheter-based valve correction) and with respect to social and professional participation. T2 - Cardiac rehabilitation KW - Koronare Herzerkrankung KW - Herzinsuffizienz KW - Herzklappenkorrektur KW - Psychosozialer Distress KW - Lebensqualität KW - Coronary artery disease KW - Heart failure KW - Heart valve correction KW - Psychosocial distress KW - Quality of life Y1 - 2020 U6 - https://doi.org/10.1007/s12181-020-00384-2 SN - 1864-9718 SN - 1864-9726 VL - 14 IS - 2 SP - 106 EP - 112 PB - Springer CY - Berlin 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 - 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 - 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 - 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 - Reibis, Rona Katharina A1 - Salzwedel, Annett A1 - Abreu, Ana A1 - Corra, Ugo A1 - Davos, Constantinos A1 - Döhner, Wolfram A1 - Doherty, Patrick A1 - Frederix, Ines A1 - Hansen, Dominique A1 - Iliou, Marie Christine A1 - Vigorito, Carlo A1 - Völler, Heinz T1 - The importance of return to work BT - How to achieve optimal reintegration in ACS patients JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action. KW - Return to work KW - acute coronary syndrome KW - predictors KW - pension insurance Y1 - 2019 U6 - https://doi.org/10.1177/2047487319839263 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 13 SP - 1358 EP - 1369 PB - Sage Publ. CY - London ER -