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Moreira J, Bravo J, Aguiar P, Delgado B, Raimundo A, Boto P. Physical and Mental Components of Quality of Life after a Cardiac Rehabilitation Intervention: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5576. [PMID: 39337063 PMCID: PMC11433594 DOI: 10.3390/jcm13185576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Background: This study aimed to analyze the effect of cardiac rehabilitation programs on the health-related quality of life of patients after a coronary cardiac event using patient-reported outcome measures (PROMs) for up to 6 months of evaluation. Methods: A comprehensive search was carried out in the MEDLINE, CINAHL, CENTRAL, and Web of Science databases for randomized controlled trials comparing the cardiac rehabilitation program with usual care. Two independent reviewers assessed the studies for inclusion, risk of bias using the Cochrane tool, and quality of evidence through the GRADE system. A meta-analysis was performed on studies assessing health-related quality of life with the SF-12 (Physical Component Summary and Mental Component Summary) up to 6 months after the program. Results: Twelve studies encompassed 2260 patients who participated in a cardiac rehabilitation program after a coronary event, with a mean age of 60.06 years. The generic PROMs used to assess quality of life were the SF-12, SF-36, EQ-5D-3L, EQ-5D-5L, and GHQ, and the specific coronary heart disease PROMs were MacNew and HeartQoL. There was a positive effect of participation in cardiac rehabilitation on the physical component of health-related quality of life at 6 months (MD [7.02]; p = 0.04] and on the mental component (MD [1.06]; p = 0.82) after applying the SF-12. Conclusions: This study highlights the significant benefits of cardiac rehabilitation programs on health-related quality of life, particularly in the physical domain at 6 months. Assessing outcomes over time through PROMs after coronary heart events is essential, thus making it possible to personalize patients' care and improve their health status.
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Affiliation(s)
- José Moreira
- Escola Superior de Enfermagem São João de Deus, University of Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-849 Évora, Portugal
| | - Jorge Bravo
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-849 Évora, Portugal
- Escola de Saúde e Desenvolvimento Humano, University of Évora, 7000-849 Évora, Portugal
| | - Pedro Aguiar
- National School of Public Health, NOVA University of Lisbon, 1600-560 Lisbon, Portugal
| | - Bruno Delgado
- Institute of Health Sciences, Catholic University of Portugal, 1649-023 Lisbon, Portugal
| | - Armando Raimundo
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-849 Évora, Portugal
- Escola de Saúde e Desenvolvimento Humano, University of Évora, 7000-849 Évora, Portugal
| | - Paulo Boto
- National School of Public Health, NOVA University of Lisbon, 1600-560 Lisbon, Portugal
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Pohl SB, Engelbertz C, Reinecke H, Malyar NM, Meyborg M, Brix TJ, Varghese J, Gebauer K. Unused potential of lipid-lowering therapy in very high-risk patients with atherosclerotic cardiovascular disease. A retrospective data analysis. Nutr Metab Cardiovasc Dis 2024; 34:1670-1680. [PMID: 38664125 DOI: 10.1016/j.numecd.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death in Europe. Although the 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the management of dyslipidaemias claim a target low-density lipoprotein cholesterol (LDL-C) value of <55 mg/dL for very high-risk patients by use of lipid-lowering therapy (LLT) and lifestyle adaptations, the target level achievement is not satisfactory. We examined LLT use in ASCVD patients exceeding LDL-C target levels at admission and its adaptations at discharge. METHODS AND RESULTS Between January 2017 and February 2020, 1091 patients with LDL-C >100 mg/dL and ASCVD defined as diagnosis of angina pectoris (AP, n = 179), acute myocardial infarction (AMI, n = 317), chronic ischemic heart disease (CHD, n = 195), or peripheral artery disease (PAD, n = 400) were extracted from hospital records. LLT use on admission and discharge as well as recommendations on lifestyle and nutrition were analysed. On admission, 51% of the patients were not taking LLT. At discharge, 91% were prescribed statins and 87% were advised on lifestyle adaptation and/or pharmacological treatment. High-intensity statin use at discharge was present in 63% of the AP-group, 92% of the AMI-group, 62% of the CHD-group and 71% of the PAD-group. Ezetimibe was present in 16% and proprotein convertase subtilisin/kexin 9 inhibitors (PCSK9i) in 1%. However, of those on high-intensity statin, 25% remained on insufficient statin dosage. CONCLUSION Switch to high-intensity statins and use of ezetimibe and PCSK9i was low in chronic ASCVD patients. Even though statin intake was high in high-risk patients, target levels were still not reached.
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Affiliation(s)
- Sarah B Pohl
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Nasser M Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Matthias Meyborg
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Julian Varghese
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Katrin Gebauer
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, 48149 Muenster, Germany.
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Kerniss H, Marín LAM, Clemens K, Litfin C, Seidel-Sarpong A, Hanses U, Rühle S, Schmucker J, Osteresch R, Fach A, Eitel I, Hambrecht R, Wienbergen H. Long-term risk factor management and adverse events in patients with early-onset myocardial infarction-a "real-world" study. Clin Res Cardiol 2024:10.1007/s00392-024-02478-3. [PMID: 38896124 DOI: 10.1007/s00392-024-02478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND International guidelines emphasize the importance of preventive efforts after early-onset myocardial infarction (EOMI); however, data on "real-world" long-term risk factor management and adverse event rates in this special patient group is scarce. METHODS In this German registry study, 301 patients with MI aged ≤ 45 years were investigated. Risk factor control was assessed at the time of index MI and after 1 year. Major adverse cardiac and cerebrovascular events (MACCE) and its predictors were analyzed during long-term follow-up (median duration 49 months). RESULTS A majority of patients with EOMI presented with insufficient risk factor control, even during 1-year follow-up. After 1-year 42% of patients were persistent smokers; 74% were physically inactive. The rate of obesity increased significantly from index MI (41%) to 1-year follow-up (46%, p = 0.03) as well as the rate of dysglycemia (index MI: 40%; 1-year follow-up: 51%, p < 0.01) and diabetes mellitus (index MI: 20%; 1-year follow-up: 24%, p < 0.01). 66% of the patients with diabetes mellitus had unsatisfactory HbA1c after 1 year; 69% of the patients did not attain guideline-recommended lipid targets. The rate of MACCE during long-term follow-up was 20% (incidence rate 0.05 per person-year). In a multivariable analysis smoking (HR 2.2, HR 1.3-3.7, p < 0.01) and physical inactivity (HR 2.8, HR 1.2-6.7, p = 0.02) were significant predictors for the occurrence of MACCE. CONCLUSION Insufficient long-term risk factor control was common in patients with EOMI and was associated with an elevated rate of MACCE. The study reveals that better strategies for prevention in young patients are crucially needed.
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Affiliation(s)
- Hatim Kerniss
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Luis Alberto Mata Marín
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Kilian Clemens
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Carina Litfin
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Annemarie Seidel-Sarpong
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Ulrich Hanses
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Stephan Rühle
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Johannes Schmucker
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Ingo Eitel
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany
| | - Harm Wienbergen
- Bremen Institute for Heart and Circulation Research (BIHKF), Senator-Weßling-Str. 2, 28277, Bremen, Germany.
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany.
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Antoniou V, Kapreli E, Davos CH, Batalik L, Pepera G. Safety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: A systematic review. Digit Health 2024; 10:20552076241237661. [PMID: 38533308 PMCID: PMC10964460 DOI: 10.1177/20552076241237661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Objective To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubmed, Scopus, Cochrane Central Register of Controlled Trials in the Cochrane Library, Cinahl and Web of Science) were reviewed from January 2012 up to August 2023. Inclusion criteria were: (a) randomized controlled trials, (b) RDCR implementation of at least 12 weeks duration, (c) assessment of safety, rates of serious adverse events (SAEs) and re-hospitalization incidences at endpoints more than 6 months. Three reviewers independently performed data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool. Results 14 studies were identified involving 2012 participants and a range of RDCR duration between 3 months to 1 year. The incidence rate of exercise-related SAEs was estimated at 1 per 53,770 patient-hours of RDCR exercise. A non-statistically significant reduction in the re-hospitalization rates and the days lost due to hospitalization was noticed in the RDCR groups. There were no exercise-related deaths. The overall study quality was of low risk. Conclusions RDCR can act as a safe alternative delivery mode of cardiac rehabilitation (CR). The low long-term rates of reported SAEs and re-hospitalization incidences of the RDCR could enhance the uptake rates of CR interventions. However, further investigation is needed in larger populations and longer assessment points.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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Heimer M, Schmitz S, Teschler M, Schäfer H, Douma ER, Habibovic M, Kop WJ, Meyer T, Mooren FC, Schmitz B. eHealth for maintenance cardiovascular rehabilitation: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1634-1651. [PMID: 37154363 DOI: 10.1093/eurjpc/zwad145] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
AIMS To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioural change techniques (BCTs). METHODS AND RESULTS A systematic review was conducted (PubMed, CINAHL, MEDLINE, and Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). Effective behavioural change techniques were defined based on the described intervention and coded according to the BCT handbook. Fourteen eligible studies (1497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02-0.70; P = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05-0.52; P = 0.02) compared with usual care. Quality of life was higher with eHealth compared with care as usual (SMD = 0.17; 95%CI 0.02-0.32; P = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared with care as usual (SMD = -0.20; 95%CI -0.40-0.00; P = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behaviour and/or goal setting as well as feedback on behaviour were most frequently included. CONCLUSION eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. REGISTRATION PROSPERO: CRD42020203578.
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Affiliation(s)
- Melina Heimer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Sandra Schmitz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Hendrik Schäfer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Emma R Douma
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Mirela Habibovic
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Willem J Kop
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Thorsten Meyer
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for Rehabilitation Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank C Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
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Wienbergen H, Fach A, Winzer EB, Schmucker J, Hanses U, Retzlaff T, Rühle S, Litfin C, Kerniss H, Marín LAM, Elsässer A, Gielen S, Eitel I, Linke A, Hambrecht R, Osteresch R. Impact of educational attainment on preventive efforts after myocardial infarction: results of the IPP and NET-IPP trials. Clin Res Cardiol 2023:10.1007/s00392-023-02285-2. [PMID: 37648751 DOI: 10.1007/s00392-023-02285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
AIMS Educational attainment might impact secondary prevention after myocardial infarction (MI). The purpose of the present study was to compare the rate of risk factors and the efficacy of an intensive prevention program (IPP), performed by prevention assistants and supervised by physicians, in patients with MI and different levels of education. METHODS In this post hoc analysis of the multicenter IPP and NET-IPP trials, patients with MI were stratified into two groups according to educational attainment: no "Abitur" (no A) vs. "Abitur" or university degree (AUD). The groups were compared at the time of index MI and after 12-month IPP vs. usual care. RESULTS Out of n = 462 patients with MI, 76.0% had no A and 24.0% had AUD. At the time of index, MI rates of obesity (OR 2.4; 95%CI 1.4-4.0), smoking (OR 2.2, 95%CI 1.4-3.6), and physical inactivity (OR 1.6; 95%CI 1.0-2.5) were significantly elevated in patients with no A. At 12 months after index MI, larger improvements of the risk factors smoking and physical inactivity were observed in patients with IPP and no A than in patients with IPP and AUD or with usual care. LDL cholesterol levels were reduced by IPP compared to usual care, with no difference between no A vs. AUD. A matched-pair analysis revealed that high baseline risk was an important reason for the large risk factor reductions in patients with IPP and no A. CONCLUSION The study demonstrates that patients with MI and lower educational level have an increased rate of lifestyle-related risk factors and a 12-month IPP, which is primarily performed by non-physician prevention assistants, is effective to improve prevention in this high-risk cohort.
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Affiliation(s)
- Harm Wienbergen
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany.
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
- Affiliated institute to the University of Lübeck, Senator-Weßling-Str. 2, 28277, Bremen, Germany.
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Ephraim B Winzer
- Heart Center Dresden, University Hospital, Department for Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Johannes Schmucker
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Ulrich Hanses
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Tina Retzlaff
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Stephan Rühle
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Carina Litfin
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Hatim Kerniss
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | | | - Albrecht Elsässer
- University Clinic for Internal Medicine, Cardiology, Oldenburg, Germany
| | - Stephan Gielen
- Department of Cardiology, Angiology, and Intensive Care Medicine Klinikum Lippe, University Clinic Ostwestfalen-Lippe, Detmold, Germany
| | - Ingo Eitel
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Axel Linke
- Heart Center Dresden, University Hospital, Department for Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
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7
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Gaebel R, Lang C, Vasudevan P, Lührs L, de Carvalho KAT, Abdelwahid E, David R. New Approaches in Heart Research: Prevention Instead of Cardiomyoplasty? Int J Mol Sci 2023; 24:ijms24109017. [PMID: 37240361 DOI: 10.3390/ijms24109017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death in industrialized nations. Due to the high number of patients and expensive treatments, according to the Federal Statistical Office (2017) in Germany, cardiovascular diseases account for around 15% of total health costs. Advanced coronary artery disease is mainly the result of chronic disorders such as high blood pressure, diabetes, and dyslipidemia. In the modern obesogenic environment, many people are at greater risk of being overweight or obese. The hemodynamic load on the heart is influenced by extreme obesity, which often leads to myocardial infarction (MI), cardiac arrhythmias, and heart failure. In addition, obesity leads to a chronic inflammatory state and negatively affects the wound-healing process. It has been known for many years that lifestyle interventions such as exercise, healthy nutrition, and smoking cessation drastically reduce cardiovascular risk and have a preventive effect against disorders in the healing process. However, little is known about the underlying mechanisms, and there is significantly less high-quality evidence compared to pharmacological intervention studies. Due to the immense potential of prevention in heart research, the cardiologic societies are calling for research work to be intensified, from basic understanding to clinical application. The topicality and high relevance of this research area are also evident from the fact that in March 2018, a one-week conference on this topic with contributions from top international scientists took place as part of the renowned "Keystone Symposia" ("New Insights into the Biology of Exercise"). Consistent with the link between obesity, exercise, and cardiovascular disease, this review attempts to draw lessons from stem-cell transplantation and preventive exercise. The application of state-of-the-art techniques for transcriptome analysis has opened new avenues for tailoring targeted interventions to very individual risk factors.
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Affiliation(s)
- Ralf Gaebel
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Cajetan Lang
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Praveen Vasudevan
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Larissa Lührs
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, Pelé Pequeno Prίncipe Research Institute & Pequeno Prίncipe Faculties, Ave. Silva Jardim, P.O. Box 80240-020, Curitiba 1632, Brazil
| | - Katherine Athayde Teixeira de Carvalho
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, Pelé Pequeno Prίncipe Research Institute & Pequeno Prίncipe Faculties, Ave. Silva Jardim, P.O. Box 80240-020, Curitiba 1632, Brazil
| | - Eltyeb Abdelwahid
- Feinberg School of Medicine, Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL 60611, USA
| | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
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8
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Wienbergen H, Hambrecht R. Stärkung der Prävention: von der Früherkennung bis zur qualifizierten Nachsorge. AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-2001-6530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ZusammenfassungAktuelle Versorgungsstudien zeigen eine alarmierende Zunahme lebensstilassoziierter kardiovaskulärer Risikofaktoren (wie Adipositas und körperliche Inaktivität) in der Bevölkerung; eine
Verstärkung dieser Entwicklung ist durch die Coronapandemie zu befürchten. Aufklärungsmaßnahmen (insbesondere in Bevölkerungsschichten mit niedrigem sozioökonomischen Status) sowie
konsequentes politische Handeln (z. B. beim Nichtraucherschutz oder bei der Steuerung von Ernährungsverhalten) sind deshalb von großer Wichtigkeit.Für die Risikostratifikation und Früherkennung von kardiovaskulären Erkrankungen bei einzelnen Personen empfehlen die aktuellen europäischen Leitlinien SCORE2 unter Beachtung von
Risikomodifikatoren (Bildgebung mit Karotis-Ultraschall oder Kardio-CT, psychosoziale und ethnische Faktoren, Begleiterkrankungen). Zukünftig werden voraussichtlich deutlich komplexere
Methoden der Risikostratifikation zur Verfügung stehen (insbesondere Genetik und künstliche Intelligenz), die aber derzeit noch nicht für den Routineeinsatz empfohlen werden.In der Nachsorge von Patienten mit manifesten Herz-Kreislauf-Erkrankungen besteht ein großer Verbesserungsbedarf zur nachhaltigen Einstellung der Risikofaktoren. Aktuelle Studien haben die
Effektivität von intensiven Langzeit-Präventions-Programmen nachgewiesen, die durch Präventions-Assistent*innen mit ärztlicher Supervision durchgeführt werden. Deshalb wurde im letzten Jahr
ein deutschlandweit standardisiertes Curriculum zur Ausbildung von kardiovaskulären Präventions-Assistent*innen eingeführt, die nun in der Praxis die präventivmedizinische Nachsorge der
Patienten*innen verbessern können.
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Kommentar zu den neuen Leitlinien (2021) der Europäischen Gesellschaft für Kardiologie (ESC) zur kardiovaskulären Prävention. DIE KARDIOLOGIE 2022. [PMCID: PMC9647766 DOI: 10.1007/s12181-022-00580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Die bedeutendste Veränderung in den neuen ESC-Leitlinien zur kardiovaskulären Prävention von 2021 betrifft die Risikoevaluation gesunder Menschen: Durch die Einführung von SCORE2 wird eine neue epidemiologische Studienbasis für die Risikoeinschätzung eingeführt, die erstmals die Berechnung der kardiovaskulären Erkrankungswahrscheinlichkeit und der kardiovaskulären Mortalität erlaubt. Zudem ermöglicht SCORE2 OP nun auch eine zuverlässige Risikobestimmung bei Menschen oberhalb des 65. Lebensjahres bis in die 9. Lebensdekade. Die Altersdynamisierung der Risikoschwellen für hohes und sehr hohes kardiovaskuläres Risiko trägt dem Gedanken der Lebenszeitexposition Rechnung, führt aber evtl. zu einer höheren Zahl behandlungspflichtiger Patienten. Mit dem 2‑Step-Approach empfiehlt die ESC eine pragmatische Herangehensweise an die Risikofaktoreinstellung: Während in Step 1 basale Präventionsziele für alle Patienten vorgegeben werden, soll der Arzt im Gespräch mit dem Patienten in Abhängigkeit von 10-Jahres-Risiko, Lebenszeitnutzen, Begleiterkrankungen und Patientenwunsch die optimalen Präventionsziele besprechen und anschließend anstreben. Leider werden in den Leitlinien die Kriterien, wer für die optimalen Präventionsziele geeignet ist, nicht klar definiert. Damit besteht die Gefahr einer subjektiven Fehleinschätzung seitens der behandelnden Ärzte, die möglicherweise vielen Patienten den Nutzen einer optimalen kardiovaskulären Prävention vorenthält. Der von den Autoren der Leitlinie hervorgehobene Gedanke des „Freedom of Choice“ könnte insofern zum Bumerang werden und zur Verwässerung der Implementierung einer optimalen Prävention führen. Hierzu und zu möglichen Verschiebungen beim Anteil behandlungsbedürftiger Patienten in der Primär- und Sekundärprävention sind in den nächsten Jahren Längsschnittstudien erforderlich, um Umsetzungsqualität und Prognosewirksamkeit zu objektivieren.
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Shi W, Ghisi GLM, Zhang L, Hyun K, Pakosh M, Gallagher R. Systematic review, meta‐analysis and meta‐regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs 2022. [DOI: 10.1111/jocn.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Gabriela L. M. Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Ling Zhang
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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11
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:643-654. [DOI: 10.1093/eurjcn/zvac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022]
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12
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1943-1944. [DOI: 10.1093/eurjpc/zwac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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The Effect of Cardiac Rehabilitation on Lipid Levels in Patients with Coronary Heart Disease. A Systematic Review and Meta-Analysis. Glob Heart 2022; 17:83. [PMID: 36578919 PMCID: PMC9717003 DOI: 10.5334/gh.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is a multidisciplinary medical program. Most studies have emphasized the effect of exercise-based CR in lowering lipid levels; however, the effect of CR as a comprehensive program on lipid levels remains unclear. Methods Electronic database were searched up to 2022. Randomized controlled trials with lipid profile indicators were included. Standardized mean differences (SMDs) and 95% CIs were used to evaluate the effect size. Begg's funnel plot and Egger's linear regression test were used to assess publication bias. Results CR remarkably reduced low-density lipoprotein cholesterol (LDL-C) levels (SMD = -0.23; 95%CI: [-0.38, -0.08]; P < 0.001), triglyceride (TG) levels (SMD = -0.17; 95%CI: [-0.28, -0.06]; P < 0.001), and total cholesterol (TC) levels (SMD = -0.30; 95%CI: [-0.43, -0.16]; P < 0.001) and increased high-density lipoprotein cholesterol (HDL-C) levels (SMD = 0.19; 95%CI: [0.10, 0.29]; P < 0.001). Conclusions CR reduce TC, TG, and LDL-C levels while improving HDL-C levels. CR should be promoted and more trials should be conducted for long-term CR.
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Effects of Supervised Cardiac Rehabilitation Programmes on Quality of Life among Myocardial Infarction Patients: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8120166. [PMID: 34940521 PMCID: PMC8703932 DOI: 10.3390/jcdd8120166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.
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15
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Osteresch R, Fach A, Frielitz FS, Meyer S, Schmucker J, Rühle S, Retzlaff T, Hadwiger M, Härle T, Elsässer A, Katalinic A, Eitel I, Hambrecht R, Wienbergen H. Long-Term Effects of an Intensive Prevention Program After Acute Myocardial Infarction. Am J Cardiol 2021; 154:7-13. [PMID: 34238446 DOI: 10.1016/j.amjcard.2021.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
Effective long-term prevention after myocardial infarction (MI) is crucial to reduce recurrent events. In this study the effects of a 12-months intensive prevention program (IPP), based on repetitive contacts between non-physician "prevention assistants" and patients, were evaluated. Patients after MI were randomly assigned to the IPP versus usual care (UC). Effects of IPP on risk factor control, clinical events and costs were investigated after 24 months. In a substudy efficacy of short reinterventions after more than 24 months ("Prevention Boosts") was analyzed. IPP was associated with a significantly better risk factor control compared to UC after 24 months and a trend towards less serious clinical events (12.5% vs 20.9%, log-rank p = 0.06). Economic analyses revealed that already after 24 months cost savings due to event reduction outweighted the costs of the prevention program (costs per patient 1,070 € in IPP vs 1,170 € in UC). Short reinterventions ("Prevention Boosts") more than 24 months after MI further improved risk factor control, such as LDL cholesterol and blood pressure lowering. In conclusion, IPP was associated with numerous beneficial effects on risk factor control, clinical events and costs. The study thereby demonstrates the efficacy of preventive long-term concepts after MI, based on repetitive contacts between non-physician coworkers and patients.
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16
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Irewall AL, Ulvenstam A, Graipe A, Ögren J, Mooe T. Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial. Sci Rep 2021; 11:15628. [PMID: 34341395 PMCID: PMC8329238 DOI: 10.1038/s41598-021-94892-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022] Open
Abstract
Enhanced follow-up is needed to improve the results of secondary preventive care in patients with established cardiovascular disease. We examined the effect of long-term, nurse-based, secondary preventive follow-up by telephone on the recurrence of cardiovascular events. Open, randomised, controlled trial with two parallel groups. Between 1 January 2010 and 31 December 2014, consecutive patients (n = 1890) admitted to hospital due to stroke, transient ischaemic attack (TIA), or acute coronary syndrome (ACS) were included. Participants were randomised (1:1) to nurse-based telephone follow-up (intervention, n = 944) or usual care (control, n = 946) and followed until 31 December 2017. The primary endpoint was a composite of stroke, myocardial infarction, cardiac revascularisation, and cardiovascular death. The individual components of the primary endpoint, TIA, and all-cause mortality were analysed as secondary endpoints. The assessment of outcome events was blinded to study group assignment. After a mean follow-up of 4.5 years, 22.7% (n = 214) of patients in the intervention group and 27.1% (n = 256) in the control group reached the primary composite endpoint (HR 0.81, 95% CI 0.68-0.97; ARR 4.4%, 95% CI 0.5-8.3). Secondary endpoints did not differ significantly between groups. Nurse-based secondary preventive follow-up by telephone reduced the recurrence of cardiovascular events during long-term follow-up.
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Affiliation(s)
- Anna-Lotta Irewall
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
| | - Anders Ulvenstam
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Anna Graipe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Joachim Ögren
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
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17
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Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid JP, Benzer W, Hackbusch M, Jensen K, Schwaab B, Altenberger J, Benjamin N, Bestehorn K, Bongarth C, Dörr G, Eichler S, Einwang HP, Falk J, Glatz J, Gielen S, Grilli M, Grünig E, Guha M, Hermann M, Hoberg E, Höfer S, Kaemmerer H, Ladwig KH, Mayer-Berger W, Metzendorf MI, Nebel R, Neidenbach RC, Niebauer J, Nixdorff U, Oberhoffer R, Reibis R, Reiss N, Saure D, Schlitt A, Völler H, von Känel R, Weinbrenner S, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med 2021; 10:2192. [PMID: 34069561 PMCID: PMC8161282 DOI: 10.3390/jcm10102192] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Karin Meng
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;
| | | | | | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Bernhard Schwaab
- Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;
| | | | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;
| | - Christa Bongarth
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Hans-Peter Einwang
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Johannes Falk
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;
| | - Stephan Gielen
- Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;
| | - Maurizio Grilli
- Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Manju Guha
- Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;
| | - Matthias Hermann
- Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;
| | - Eike Hoberg
- Wismarstraße 13, D-24226 Heikendorf, Germany;
| | - Stefan Höfer
- Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;
| | - Harald Kaemmerer
- Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;
| | - Wolfgang Mayer-Berger
- Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;
| | - Rhoia Clara Neidenbach
- Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Uwe Nixdorff
- EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;
| | - Renate Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;
| | - Rona Reibis
- Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Axel Schlitt
- Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;
| | - Susanne Weinbrenner
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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18
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Werba JP, Bonomi A, Giroli M, Amato M, Vigo L, Agrifoglio M, Alamanni F, Cavallotti L, Kassem S, Naliato M, Parolari A, Penza E, Polvani G, Pompilio G, Porqueddu M, Roberto M, Salis S, Zanobini M, Amato M, Baldassarre D, Veglia F, Tremoli E. Long-term secondary cardiovascular prevention programme in patients subjected to coronary artery bypass surgery. Eur J Prev Cardiol 2020; 29:997-1004. [PMID: 33624003 DOI: 10.1093/eurjpc/zwaa060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022]
Abstract
AIMS Patients with coronary heart disease (CHD) are at very high risk of recurrent events. A strategy to reduce excess risk might be to deliver structured secondary prevention programmes, but their efficacy has been mostly evaluated in the short term and in experimental settings. This is a retrospective case-control study aimed at assessing, in the real world, the efficacy of a secondary prevention programme in reducing long-term coronary event recurrences after coronary artery bypass surgery (CABG). METHODS AND RESULTS Programme participants (henceforth 'cases') were men and women aged <75 years subjected to CABG between 2002 and 2014, living within 100 km of the hospital. Key programme actions included optimization of treatments according to the most updated European preventive guidelines, surveillance of therapy adherence, and customized lifestyle counselling. Controls were analogous patients not involved in the programme because living farther than 100 km away, matched 1:1 with cases for gender, age at CABG, and year of CABG. Both groups (n = 1248) underwent usual periodic cardiology follow-up at our centre. Data on symptomatic or silent CHD recurrences were obtained from the hospital electronic health records. Cox analysis (adjusted for baseline differences between groups) shows that programme participation was associated with a significantly lower incidence throughout 5 years post-CABG of symptomatic [hazard ratio (95% confidence interval): 0.59 (0.38-0.94)] and silent [0.53 (0.31-0.89)] coronary recurrences. CONCLUSION In a real-world setting, taking part in a structured longstanding secondary prevention programme, in addition to usual cardiology care, meaningfully lowers the risk of coronary recurrences.
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Affiliation(s)
- José Pablo Werba
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Monica Giroli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Manuela Amato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda, 10, 20122, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Laura Cavallotti
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Samer Kassem
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Moreno Naliato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alessandro Parolari
- UOC University Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Eleonora Penza
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Gianluca Polvani
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Massimo Porqueddu
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Al Kurnaysh Rd, Al Andalus, 23311, Jeddah, Saudi Arabia
| | - Maurizio Roberto
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Stefano Salis
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Marco Zanobini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Mauro Amato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20133, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
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Wienbergen H, Fach A, Langer H, Hambrecht R. Update Lebensstil – Was funktioniert in der Praxis? AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1130-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungAktuelle Versorgungsstudien zeigen eine alarmierende Zunahme Lebensstil-assoziierter kardiovaskulärer Risikofaktoren, wie Adipositas und körperliche Inaktivität, in der Gesamtbevölkerung und bei Patienten mit Herz-Kreislauf-Erkrankungen. Um dem entgegenzuwirken, ist es wichtig, Patienten nach Koronarereignissen langfristig zu Verhaltensänderungen zu motivieren. Eine kürzlich publizierte Studie zeigte, dass ein intensives Präventionsprogramm (IPP) für 12 Monate, das primär von nicht ärztlichen Präventionsassistenten durchgeführt wurde und auf engmaschigen Kontakten zu den Patienten beruhte, die kardiovaskulären Risikofaktoren nachhaltig besser einstellen konnte. In der Gesamtbevölkerung ist eine Anleitung zu Lebensstilmodifikationen in verschiedenen Lebensphasen wichtig: beginnend im Kindes- und Jugendalter, über das Berufsleben, bis hin zum Rentenalter. Ein besonders hoher Bedarf besteht in Bevölkerungsschichten mit niedrigem sozioökonomischen Status. Durch präventive
Maßnahmen, wie Aufklärung zu mehr Bewegung, gesunder Ernährung und Nicht-Rauchen, kann hier ein großer Beitrag geleistet werden, die kardiovaskuläre Morbidität und Letalität zu senken.
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Affiliation(s)
- Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Andreas Fach
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
| | - Harald Langer
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Rainer Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
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Wienbergen H, Fach A, Erdmann J, Katalinic A, Eisemann N, Krawitz P, Maj C, Borisov O, Munz M, Noethen M, Meyer-Saraei R, Osteresch R, Schmucker J, Linke A, Eitel I, Hambrecht R, Langer H. New technologies for intensive prevention programs after myocardial infarction: rationale and design of the NET-IPP trial. Clin Res Cardiol 2020; 110:153-161. [DOI: 10.1007/s00392-020-01695-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022]
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Piepoli MF. Editor’s presentation: ‘Les liaisons dangereuses. The heart in the time of COVID-19’. Eur J Prev Cardiol 2020; 27:1011-1013. [PMID: 32583735 PMCID: PMC7717246 DOI: 10.1177/2047487320936413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G da Saliceto Hospital, Italy
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Italy
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22
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Fach A, Osteresch R, Erdmann J, Munz M, Alberto Mata Marin L, Michel S, Retzlaff T, Wettwer T, Schmucker J, Hambrecht R, Wienbergen H. Long-term prevention after myocardial infarction in young patients ≤45 years: the Intensive Prevention Program in the Young (IPP-Y) study. Eur J Prev Cardiol 2019; 27:2264-2266. [PMID: 31674209 DOI: 10.1177/2047487319883960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andreas Fach
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Rico Osteresch
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany
| | - Matthias Munz
- Institute for Cardiogenetics, University of Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany.,Department of Periodontology and Synoptic Dentistry, Charité - University Medicine Berlin, Germany
| | | | - Stephan Michel
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Tina Retzlaff
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Tineke Wettwer
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Johannes Schmucker
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Rainer Hambrecht
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Harm Wienbergen
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany
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Bosselmann L, Fangauf SV, Herbeck Belnap B, Chavanon ML, Nagel J, Neitzel C, Schertz A, Hummers E, Wachter R, Herrmann-Lingen C. Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study. Eur J Cardiovasc Nurs 2019; 19:134-141. [PMID: 31564125 DOI: 10.1177/1474515119880062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors. AIMS The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany. METHODS For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20). RESULTS Participation rate in the intervention phase was 67% (n=40), and participants reported high satisfaction (M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group (t(60)=3.07, p=0.003), but not in the waiting control group t(60)=-0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors (t(60)=3.88, p<0.001). CONCLUSION This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.
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Affiliation(s)
- Lena Bosselmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Stella V Fangauf
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, USA
| | | | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
| | - Claudia Neitzel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Anna Schertz
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany
| | - Eva Hummers
- Department of General Practice, University of Göttingen Medical Center, Germany
| | - Rolf Wachter
- German Center for Cardiovascular Research (DZHK), Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Germany.,German Center for Cardiovascular Research (DZHK), Germany
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Long-Term Risk Factor Control After Myocardial Infarction-A Need for Better Prevention Programmes. J Clin Med 2019; 8:jcm8081114. [PMID: 31357619 PMCID: PMC6723668 DOI: 10.3390/jcm8081114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on health care data regarding RFC after MI and presents recent trials on modern preventive strategies that support patients to achieve risk factor targets during long-term course. Results: International registry studies, such as EUROASPIRE, observed alarming deficiencies in RFC after MI. As data of the German Bremen ST-segment elevation myocardial infarction (STEMI)-Registry show, most deficiencies are found in socially disadvantaged city districts and in young patients. Several studies on prevention programmes to improve RFC after MI reported inconsistent data; however, in the recently published IPP trial a 12-months intensive prevention programme that included both repetitive personal contacts with non-physician prevention assistants and telemetric risk factor control, was associated with significant improvements of numerous risk factors (smoking, LDL and total cholesterol, systolic blood pressure and physical inactivity). Conclusions: There is a strong need of action to improve long-term risk RFC after MI, especially in socially disadvantaged patients. Modern prevention programmes, using personal and telemetric contacts, have large potential to support patients in achieving long-term risk factor targets after coronary events.
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