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DOI: 10.1055/s-0043-120904
Kardiologische Rehabilitation
Cardiac RehabilitationPublikationsverlauf
Publikationsdatum:
07. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/rehabilitation/201802/lookinside/thumbnails/461_10-1055-s-0043-120904-1.jpg)
Zusammenfassung
Die Rehabilitation kardiovaskulärer Erkrankungen stellt eine multimodale Intervention auf somatischer, psychologischer, edukativer und sozialer Ebene durch ein interdisziplinäres Team dar und beinhaltet neben der Optimierung der medizinischen Sekundärprävention zur Reduktion von Morbidität und Mortalität auch die Verbesserung der körperlichen Leistungsfähigkeit und der Lebensqualität sowie die Wiedereingliederung in das soziale und Erwerbsleben. In 5 kontrollierten Kohortenstudien an 12 556 Patienten aus Deutschland konnte gezeigt werden, dass eine Anschlussrehabilitation nach akutem Myokardinfarkt und nach Bypass-Operation die Gesamtmortalität, die Reinfarktrate und die Hospitalisierung im Verlauf von 1–2 Jahren signifikant senkte. Diese Ereignisreduktion gelang zusätzlich zu einer interventionellen Akuttherapie und einer evidenzbasierten medikamentösen Sekundärprävention. 3 internationale Metaanalysen bestätigen diese nationalen Ergebnisse für Patienten mit Koronarer Herzkrankheit. Eine kardiologische Rehabilitation wird in nationalen und internationalen Leitlinien auch empfohlen für Patienten nach Herzklappenoperation und -intervention, nach dekompensierter Herzinsuffizienz, nach Herztransplantation sowie nach ICD-, CRT- und VAD-Implantation. Die Absicherung der Evidenz der kardiologischen Rehabilitation in Deutschland durch einen RCT wäre wünschenswert. Darüber hinaus sollten die multimodalen Interventionen noch individueller auf spezifische Patientengruppen (Hochbetagte, Gebrechliche), Indikationen (TAVI, VAD) sowie Komorbiditäten (pAVK, T2DM) ausgerichtet und besondere berufliche Problemlagen konsequent berücksichtigt werden. Die kardiologische Rehabilitation sollte integraler Bestandteil jeder Versorgung sein, die sich am dauerhaften Therapieerfolg orientiert.
Abstract
Physical training, psychosocial intervention, nutrition counselling and optimisation of secondary preventive medication to reduce morbidity and mortality of the disease as well as the reintegration into social life and return to work are equivalent goals of cardiac rehabilitation. This requires multifactorial intervention by a multidisciplinary team. In Germany, cardiac rehabilitation starting early after an index event could demonstrate a significant reduction of total mortality, myocardial infarction and hospitalisation during a follow-up of 1–2 years in 5 controlled cohort studies including 12 556 patients after myocardial infarction and CABG surgery. The reduction of clinical events was obtained in addition to rapid revascularisation therapy during the acute coronary event and on top of evidence based medication. In national and international guidelines, cardiac rehabilitation is recommended as well after valve surgery or intervention, in patients with heart failure and after ICD-, CRT- and VAD-implantation. Cardiac rehabilitation in Germany should be evaluated in a randomised controlled trial as well. In addition, multifactorial interventions should be tailored individually to specific patient subgroups, medical conditions and comorbidities. Return to work should be emphasized as a major topic of cardiac rehabilitation.
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