Ärztliche Betreuung von ambulanten Herzgruppen

Wienbergen, Harm; Schwaab, Bernhard; Bjarnason-Wehrens, Birna; Guha, Manju; Laszlo, Roman; Burgstahler, Christof; Haehling, Stephan von; Halle, Martin; Zahn, Ralf; Hambrecht, Rainer

doi:10.1007/s12181-020-00433-w

Cited by 10 publications

(11 citation statements)

References 45 publications

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“…Only recently (January 2020) has this large patient group been specifically addressed in a position paper of the German Cardiac Society, which made a request to implement dedicated heart failure training groups in Germany. Meanwhile, a respective reimbursement scheme for heart failure training groups has been approved, which allow for the higher supervision efforts compared to conventional HSGs [6]. Due to the COVID-19 induced lockdown, uptake of heart failure training groups has been poor, thus experiences with and evidence arising from heart failure training groups are still sparse.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, they should not necessarily lead to a discontinuation of training sessions [28,29]. Physicianguided training might be of even of higher importance in patients with advanced heart diseases than in healthier cardiovascular subjects attending the conventional HSGs [6].…”

Section: Discussionmentioning

confidence: 99%

“…Further, patients in our study sample differed in several points from patients considered eligible for participation in heart failure training groups by the position paper (i.e., LVEF < 40%, NYHA functional class III, etc. [6].). The optimal criteria for group composition still need to be clarified.…”

Section: Limitations and Strengthsmentioning

confidence: 98%

“…Despite well-established evidence and guidelines recommending physical activity to improve health-related quality of life and to reduce hospitalization rates in patients with heart failure, their participation in the above-mentioned HSGs is heavily underrepresented, most likely because of their perceived higher risk for cardiovascular events during training sessions [3][4][5]. However, multiple studies over the last three decades consistently reported that the risk of events like sudden cardiac death, cardiac arrest, or myocardial infarction in exercising patients with cardiovascular diseases was small, and progressively diminished over the years [6]. Nevertheless, heart failure patients carry a higher baseline risk, which might be particularly increased for unfit or previously sedentary patients performing uncontrolled or even vigorous (un-)supervised training [7].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, heart failure patients carry a higher baseline risk, which might be particularly increased for unfit or previously sedentary patients performing uncontrolled or even vigorous (un-)supervised training [7]. Therefore, and complementary to established HSGs, the German Society for Prevention and Rehabilitation and the German Society for Cardiology in 2020 claimed the establishment of dedicated "Heart Failure Training Groups" for patients with heart failure and limited exercise capacity, who cannot participate in conventional HSGs [6,8].…”

Section: Introductionmentioning

confidence: 99%

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Establishing a cardiac training group for patients with heart failure: the “HIP-in-Würzburg” study

et al. 2021

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Background Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated “HF training groups.” Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany. Methods Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ). Results All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO2% predicted, from 66.5 [49; 77] to 67 [52; 78]; p for trend = 0.03. The physical function and social limitation domains of the KCCQ improved from 60 [54; 82] to 71 [58; 95, and from 63 [39; 83] to 78 [64; 92]; p for trend = 0.04 and = 0.01, respectively. Positive trends were further seen for the clinical and overall summary scores. Conclusion This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.

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Section: Discussionmentioning

confidence: 99%