Inpatient Cardiac Rehabilitation of LVAD Patients—Updated Recommendations from the Working Group of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases

Reiss, Nils; Schmidt, Thomas A.; Langheim, Eike; Bjarnason-Wehrens, Birna; Marx, R.; Sindermann, Jürgen R.; Knoglinger, Ernst

doi:10.1055/s-0039-1691837

Cited by 13 publications

(26 citation statements)

References 79 publications

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“…For hemodynamically stable VAD-patients, the participation in medically supervised and individually adapted ET is suggested [ 107 , 108 , 109 , 110 ]. (↑ 100%)…”

Section: Results and Evidence-based Recommendations For Contents And Application Of Ebcrmentioning

confidence: 99%

“…It is recommended (↑↑ 100%) that all therapists (physicians, physiotherapist, exercise therapist) entrusted with ET in VAD-patients demonstrate in-depth knowledge in this field, based on current VAD-guidelines [ 108 , 110 ] that the ET is led by experienced, well-trained exercise therapists, who are familiar with the VAD-systems used, safety aspects, and special emergency management [ 108 , 110 ]. …”

Section: Results and Evidence-based Recommendations For Contents And Application Of Ebcrmentioning

confidence: 99%

“…For hemodynamically stable VAD-patients, the participation in medically supervised and individually adapted ET is suggested [107][108][109][110] All exercises for the abdominal and back muscles are not recommended [108,110]. (↓↓ 100%)…”

mentioning

confidence: 99%

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Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

Schwaab

Bjarnason-Wehrens

Meng

et al. 2021

JCM

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Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.

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“…For hemodynamically stable VAD-patients, the participation in medically supervised and individually adapted ET is suggested [ 107 , 108 , 109 , 110 ]. (↑ 100%)…”

Section: Results and Evidence-based Recommendations For Contents And Application Of Ebcrmentioning

confidence: 99%

Section: Results and Evidence-based Recommendations For Contents And Application Of Ebcrmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

Schwaab

Bjarnason-Wehrens

Meng

et al. 2021

JCM

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“…In light of the complexity of VAD-systems and the severity of the underlying disease, a specialized care after VAD implantation is undisputable, and-according to existing guidelines-exercise-based CR is regarded to be safe [91][92][93][94]. CR including aerobic exercise training and dynamic stress training was associated with an increase in VO 2max , 6-min walking test distance, and quality of life [95][96][97][98][99].…”

Section: Scientific Evidencementioning

confidence: 99%

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

Rauch

Salzwedel

Bjarnason-Wehrens

et al. 2021

JCM

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Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. 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.

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“…Curriculum Herzinsuffizienz der Deutschen Rentenversicherung Bund (modifiziert nach[8]). Die Rehabilitation von Patienten mit VAD dient einerseits der Vorbereitung auf das Leben mit einem VAD in der häus lichen Situation inklusive der Vermeidung von Komplika tionen der VAD-Therapie, andererseits dem Aufbau eines für die Durchführung der täglichen Anforderungen ausrei chenden Leistungsvermögens und der psychosoziale Un terstützung bei der Krankheitsbewältigung[41].…”

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Rehabilitation bei Herzinsuffizienz

Reibis¹,

Schlitt²,

Langheim³

et al. 2020

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin

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Die Herzinsuffizienz führt jährlich in Deutschland zu Behandlungskosten in Höhe von >5 Mrd. Euro. Die weltweite Prävalenz soll in den nächsten 15 Jahren um 25% zunehmen, und es ist mit einem Anstieg der Krankheitskosten um über 200% zu rechnen. Gründe sind u.a. die Zunahme kostenintensiver Prozeduren und die Abnahme der Krankenhausmortalität. Durch das multimodale Programm der Rehabilitation kann dieser Kreislauf unterbrochen werden.

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Inpatient Cardiac Rehabilitation of LVAD Patients—Updated Recommendations from the Working Group of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases

Cited by 13 publications

References 79 publications

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

Rehabilitation bei Herzinsuffizienz

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