Search

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The benefits of rehabilitation following coronary artery surgery have been well documented but only three controlled trials following valve surgery with a total of 295 patients have been published to date. These studies have demonstrated similar benefits from exercise training with an increase in VO2 or work capacity at short term and up to 12 months after surgery. Insufficient data exist about a rise in quality of life (QOL) and about return to work which tended only to be facilitated. A multidisciplinary rehabilitation program should be offered for patients undergoing valve surgery. Besides exercise training and psychological counseling patients should be educated about anticoagulation, including drug interaction and self-management if appropriate, about the recognition of important symptoms and about the elements of a healthy lifestyle.In TAvI patients, several well designed and controlled trials show that rehabilitation in these elderlypatients with higher comorbidities is safe and leads to improvement of exercise capacity and improvement in disability favoring home discharge with more independent life at home. Further researchis needed in patients after cardiac valve surgery to address the question of mortality benefits, as well as quality of life, cost effectiveness and return to work.KEY WORDS: Rehabilitation, Cardiac valve, Mortality, Work Capacity, Quality Of Life

Care of patients with pulmonary arterial hypertension (PAH) needs a multi-facetet concept and measures, including management of adverse reactions, right heart insufficiency as well as information on pregnancy, travels by air, psychosocial support, physical exercise training and prophylaxis by vaccination.Positive study results led to an higher recommendation of specialized exercise training in pulmonary hypertension. Also, the recommendation on iron substitution was amended according to the current evidence.In the current guidelines, special focus was given to the elaboration of recommendations regarding pregnancy, including patient information, contraception and patient management in case of pregnancy.This article aims to provide an overview on the recommendations of general measuremes, special circumstances and patient management according to the ESC/ERS guidelines. Amendments to the guideline recommendations are given as comments from the authors of this article., Competing Interests: M.L.: Unterstützung zur Teilnahme an medizinischen Kongressen/Fort- und Weiterbildungen: MSD, Orpha Swiss, Janssen. Advisory Boards: MSD (bezahlt), Orpha Swiss (unbezahlt).S.H., R.N., F.M.W., S.U., A.F.: kein Interessenkonflikt.E.G. hat Honorare für Vorträge/Konsultationen von Bayer/MSD, Ferrer, GEBRO, GSK, Janssen und OMT erhalten. Forschungsförderung für klinische Studien wurde von Acceleron, Actelion, BayerHealthCare, MSD, Bellerophon, GossamerBio, Janssen, Novartis, OMT, Pfizer, REATE und United Therapeutics erhalten.H.J.K.: Reise-/Übernachtungskosten, Honorare, Forschungsunterstützung von folgenden Firmen: Anamed; AstraZeneca; Bayer; Berlin Chemie/Menarini; Bezirksärztekammer Südbaden, Boehringer Ingelheim; Chiesi; Daiichi-Sankyo; Deutsche Forschungsgemeinschaft; Dräger; Fisher & Paykel Healthcare; Grifols; GSK; Heinen & Löwenstein; Janssen Johnson & Johnson; Lilly; MSD; Mundipharma; Novartis; Pfizer; Portola; Philips Healthcare; Pulmonx; ResMed; Roche; Sanofi Genzyme; Sapio Life; Weinmann.D.R. erhielt Honorare für Vortragstätigkeiten von Janssen und MSD.N.B. erhielt Honorare für Vortragstätigkeit durch das Universitätsspital Zürich., (Thieme. All rights reserved.)

Aims: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH)., Methods and Results: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group., Conclusion: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Background: Rehabilitation aftercare programs can enable patients with cardiovascular disease to sustain and improve achievements made during their rehabilitation. However, not every patient is able to attend outpatient aftercare programs, especially if they interfere with professional or social responsibilities. Telemedical alternatives could provide those patients with longer durations or varying degrees of aftercare, regardless of location or time restriction. The present study aimed to investigate what cardiovascular rehabilitation patients expect from a telemedical aftercare program., Methods: Data was collected in individual semi-structured interviews with cardiovascular rehabilitation patients, where subjects were asked about their expectations towards a telemedical aftercare program. To identify groups of associated topics, the results obtained were analyzed using qualitative content analysis., Results: Nine cardiovascular rehabilitation patients were interviewed (8 male, 1 female). None of the respondents had ever taken part in a telemedical aftercare program; however, eight out of the nine patients indicated their willingness to participate in such a program. Patients preferred telephone-based aftercare programs where they could speak with a member of staff familiar with the patient's clinical picture, circumstances and goals. Some respondents wanted additional web-based services or services via text message., Conclusions: Overall, the option of telemedical aftercare was viewed favorably by rehabilitation patients as long as the program included personal contact with a healthcare provider. Respondents preferred interaction via familiar media, especially by phone. Low-threshold experiences with new technologies may help overcome reservations and facilitate acceptance of innovative telemedical services in rehabilitation patients. Personal interaction with an attending member of staff should occur throughout aftercare programs, at least occasionally or during initial the stage., (Copyright © 2019. Published by Elsevier GmbH.)

Aims: The impact of exercise training on the right heart and pulmonary circulation has not yet been invasively assessed in patients with pulmonary hypertension (PH) and right heart failure. This prospective randomized controlled study investigates the effects of exercise training on peak VO2/kg, haemodynamics, and further clinically relevant parameters in PH patients., Methods and Results: Eighty-seven patients with pulmonary arterial hypertension and inoperable chronic thrombo-embolic PH (54% female, 56 ± 15 years, 84% World Health Organization functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO2/kg. Secondary endpoints included changes in haemodynamics. For missing data, multiple imputation and responder analyses were performed. The study results showed a significant improvement of peak VO2/kg in the training group (difference from baseline to 15 weeks: training +3.1 ± 2.7 mL/min/kg equals +24.3% vs. control -0.2 ± 2.3 mL/min/kg equals +0.9%, P < 0.001). Cardiac index (CI) at rest and during exercise, mean pulmonary arterial pressure, pulmonary vascular resistance, 6 min walking distance, quality of life, and exercise capacity significantly improved by exercise training., Conclusion: Low-dose exercise training at 4-7 days/week significantly improved peak VO2/kg, haemodynamics, and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicentre trials are necessary to confirm these results., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Purpose: Exercise training as an add-on to medical therapy has been shown to improve exercise capacity, quality of life, and possibly prognosis in patients with pulmonary hypertension (PH). The purpose of this study was to analyze the impact of exercise training on healthcare costs in PH., Methods: Estimated healthcare costs have been compared between patients with severe PH under optimized medical therapy only (control group) versus patients who received exercise training as an add-on to medical therapy (training group). Cost-analysis included a cost-estimation model of costs for baseline and follow-up visits and all PH-related healthcare events that occurred within the follow-up period. Time to clinical worsening and survival were assessed by clinical records, phone, and/or control visits., Results: At baseline, the training (n = 58) and control group (n = 48) did not differ in age, gender, WHO-functional class, 6-min walking distance, hemodynamic parameters, or PH-targeted medication. During a follow-up of 24 ± 12 months, the training group had significantly better survival rates at 1 and 3 years and less worsening events (death, lung transplantation, hospitalization due to PH, new PAH-targeted medication) than the control group (15 vs. 25 events, p < 0.05), which also led to lower estimated healthcare costs of 657 within a period of 2 years., Conclusions: This is the first study to investigate the cost-effectiveness of exercise training in PH. Due to less worsening events within 2 years, healthcare costs were lower in patients performing exercise training as add-on to medical therapy than in patients with medical treatment only. Further prospective, randomized studies are needed to confirm these findings.

A 51-year-old obese woman who had just undergone a second osteotomy for arthrosis of the hip joint was given unfractionated heparin, 7,500 IU subcutaneously three times daily, as thrombosis prophylaxis. Signs of fulminant pulmonary embolism occurred on the 16th postoperative day with a platelet count of 33,000/microliters. Suspected heparin-induced thrombocytopenia and thrombosis (HITT) was confirmed by platelet tests. When heparin had been discontinued immunoglobulin G was administered, seven times 5 g intravenously, in view of the immunological genesis of HITT. In addition thrombolysis treatment with streptokinase combined with phenprocoumon was undertaken, until satisfactory anticoagulation was achieved after 4 days. Platelet count rose to 136,000/microliters within 20 hours of the first immunoglobulin dose. Complete clinical normality was restored, scintigraphy showed no perfusion deficit in the lungs.

A series of nosocomial Legionella infections in a rehabilitation center is reported. In a three months period a total of 10 pneumonias with 3 deaths occurred (8 patients, 1 companion, 1 staff member). Serologic analysis proved additional Legionella infections within the nursing staff. The warm-water system was proved to be the source of infection by isolating Legionella pneumophila serogroup 1 subtype Pontiac both in warm-water and patients samples. The air conditioning system could not be ruled out as another (secondary) route of exposure because of shortcomings in construction. Conclusions about prevention and the course of the disease are discussed and standards for warm-water and air conditioning systems are proposed.

Spontaneous bacterial peritonitis (SBP) constitute a rare complication of cirrhosis of the liver with a high mortality rate. Unspecific sings of decompensation like increasing elaboration of ascites or the development of hepatic encephalopathy are often prevailing. Fever and peripheral blood leukocytosis as well as abdominal sings of peritonitis are not rarely completely missing. There is a strong suspicion of SBP with an ascitic polymorphonuclear count of greater than 500/mm3. Determination of lactate and pH in the ascitic fluid can increase diagnostic sensitivity and specificity if the leukocyte count is dubious. Gram negative rods predominate with over 70% whereas anaerobic organisms appear to be very rare. A 49 year old patient is presented and diagnostic and therapeutic strategies reviewed. In view of the high mortality every clinical deterioration of patients with cirrhosis should alert the physician of the presence of SBP.

A deep-vein thrombosis developed in a 71-year-old patient on the eleventh day of heparin treatment (25,000 U intravenously over 24 hours) given because of a nontransmural anterior-wall infarct. Subsequently there occurred a unilateral and then bilateral thrombotic occlusion of the femoral arteries and thrombosis of the infrarenal artery with occlusion of the right renal artery which necessitated operative thrombectomy. Platelet count, initially 370,000/microliters, fell to 34,000/microliters. No source of emboli was found either echocardiographically or by thoracic and abdominal computed tomography. After heparin administration had been discontinued on the 15th day, platelet count quickly returned to normal. Rapidly progressing demarcation necessitated amputation of both legs. The patient died on the 23rd hospital day. The reported findings indicate a heparin-induced thrombosis-thrombocytopenia syndrome.