Hahmann H W
Klinik Schwabenland, 88316, Isny-Neutrauchburg, Deutschland.
Herz. 2012 Feb;37(1):22-9. doi: 10.1007/s00059-011-3559-8.
The goal of cardiac rehabilitation is to support heart patients using a multidisciplinary team in order to obtain the best possible physical and mental health and achieve long-term social reintegration. In addition to improving physical fitness, cardiac rehabilitation restores self-confidence, thus better equipping patients to deal with mental illness and improving their social reintegration ("participation"). Once the causes of disease have been identified and treated as effectively as possible, drug and lifestyle changes form the focus of cardiac rehabilitation measures. In particular diseases, rehabilitation offers the opportunity for targeted educational courses for diabetics or drug dose escalation, as well as special training for heart failure patients. A nationwide network of outpatient heart groups is available for targeted follow-up. Cardiac patients predominantly rehabilitated in follow-up rehabilitation are older and have greater morbidity than in the past; moreover, they generally come out of acute clinical care earlier and are discharged from hospital more quickly. The proportion of severely ill and multimorbid patients presents a diagnostic and therapeutic challenge in cardiac rehabilitation, although cardiac rehabilitation was not initially conceived for this patient group. The benefit of cardiac rehabilitation has been a well documented reduction in morbidity and mortality. However, hurdles remain, partly due to the patients themselves, partly due to the health insurers. Some insurance providers still refuse rehabilitation for non-ST-segment elevation infarction. In principle rehabilitation can be carried out in an inpatient or an outpatient setting. Specific allocation criteria have not yet been established, but the structure and process quality of outpatient rehabilitation should correspond to that of the inpatient setting. The choice between the two settings should be based on pragmatic criteria. Both settings should be possible for an individual patient. Cardiac rehabilitation is already focusing on older, sicker and polymorbid patients; this will become ever more the case in the future. There is still a need for future clinical research for these patients.
心脏康复的目标是通过多学科团队为心脏病患者提供支持，以使其获得尽可能最佳的身心健康，并实现长期的社会重新融入。除了提高身体素质外，心脏康复还能恢复自信心，从而使患者更有能力应对精神疾病并改善其社会重新融入（“参与度”）。一旦尽可能有效地确定并治疗了疾病原因，药物和生活方式的改变就成为心脏康复措施的重点。对于特定疾病，康复为糖尿病患者提供了针对性教育课程或药物剂量调整的机会，也为心力衰竭患者提供了特殊培训。全国范围内有一个门诊心脏康复小组网络可用于针对性的随访。与过去相比，在后续康复中接受主要康复治疗的心脏病患者年龄更大，发病率更高；此外，他们通常更早地从急性临床护理中康复并更快出院。重症和多病共存患者的比例给心脏康复带来了诊断和治疗方面的挑战，尽管心脏康复最初并非针对这一患者群体设计。心脏康复的益处已被充分证明能降低发病率和死亡率。然而，障碍仍然存在，部分原因在于患者自身，部分原因在于健康保险公司。一些保险提供商仍拒绝为非ST段抬高型心肌梗死患者提供康复治疗。原则上，康复可在住院或门诊环境中进行。尚未确立具体的分配标准，但门诊康复的结构和过程质量应与住院环境相当。两种环境的选择应基于实际标准。对于个体患者，两种环境都应可行。心脏康复已经在关注年龄更大、病情更重和多病共存的患者；未来这种情况将更加普遍。对于这些患者，未来仍需要进行临床研究。
