Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1.
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Rauch Bernhard, Salzwedel Annett, Bjarnason-Wehrens Birna, Albus Christian, Meng Karin, Schmid Jean-Paul, Benzer Werner, Hackbusch Matthes, Jensen Katrin, Schwaab Bernhard, Altenberger Johann, Benjamin Nicola, Bestehorn Kurt, Bongarth Christa, Dörr Gesine, Eichler Sarah, Einwang Hans-Peter, Falk Johannes, Glatz Johannes, Gielen Stephan, Grilli Maurizio, Grünig Ekkehard, Guha Manju, Hermann Matthias, Hoberg Eike, Höfer Stefan, Kaemmerer Harald, Ladwig Karl-Heinz, Mayer-Berger Wolfgang, Metzendorf Maria-Inti, Nebel Roland, Neidenbach Rhoia Clara, Niebauer Josef, Nixdorff Uwe, Oberhoffer Renate, Reibis Rona, Reiss Nils, Saure Daniel, Schlitt Axel, Völler Heinz, von Känel Roland, Weinbrenner Susanne, Westphal Ronja, On Behalf Of The Cardiac Rehabilitation Guideline Group
Аннотация
METHODS: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation.
RESULTS: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs.
CONCLUSIONS: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.