Rauch Bernhard, Salzwedel Annett, Bjarnason-Wehrens Birna, Albus Christian, Meng Karin, Schmid Jean-Paul, Benzer Werner, Hackbusch Matthes, Jensen Katrin, Schwaab Bernhard, Altenberger Johann, Benjamin Nicola, Bestehorn Kurt, Bongarth Christa, Dörr Gesine, Eichler Sarah, Einwang Hans-Peter, Falk Johannes, Glatz Johannes, Gielen Stephan, Grilli Maurizio, Grünig Ekkehard, Guha Manju, Hermann Matthias, Hoberg Eike, Höfer Stefan, Kaemmerer Harald, Ladwig Karl-Heinz, Mayer-Berger Wolfgang, Metzendorf Maria-Inti, Nebel Roland, Neidenbach Rhoia Clara, Niebauer Josef, Nixdorff Uwe, Oberhoffer Renate, Reibis Rona, Reiss Nils, Saure Daniel, Schlitt Axel, Völler Heinz, von Känel Roland, Weinbrenner Susanne, Westphal Ronja
Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany.
Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany.
J Clin Med. 2021 May 19;10(10):2192. doi: 10.3390/jcm10102192.
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.
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 " (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.
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.
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.
尽管心血管康复（CR）总体上已被广泛接受，但欧洲各国之间的CR参与率和实施情况仍存在很大差异。此外，CR对多种心血管疾病的临床和预后影响尚未明确确立。
本指南涵盖了CR的各个方面，包括适应症、内容和实施。在制定指南的过程中，每一步都由“（德国医学科学院）”的独立成员进行外部监督和审核。进行了四项荟萃分析，以评估急性冠状动脉综合征（ACS）后、冠状动脉搭桥术（CABG）后、重度慢性收缩性心力衰竭（HFrEF）患者中CR的预后效果，并确定CR期间心理干预的效果。所有其他CR实施的适应症均基于预先定义的半结构化文献检索，并通过包括所有参与指南制定的医学协会在内的正式同意程序确定推荐意见。
多学科CR与ACS患者和CABG患者的全因死亡率显著降低相关，而HFrEF患者（左心室射血分数<40%）在运动能力和健康相关生活质量方面尤其受益。其他心血管疾病患者也从参与CR中获益，但科学证据尚不明确。越来越多的证据表明，CR的有益效果很大程度上取决于“治疗强度”，包括医学监督、心血管危险因素的治疗、信息和教育，以及至少个体化调整的运动量。应根据个体需求进行额外的心理干预。
这些指南强化了CR在特定临床适应症中的显著益处，但也描述了临床实践中CR实施以及CR科学在方法和呈现方面仍存在的不足。
