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Cardiac rehabilitation in Austria: short term quality of life improvements in patients with heart disease

Stationäre Rehabilitation in Österreich: direkte Verbesserung der gesundheitsbezogenen Lebensqualität von Herzkreislaufpatienten

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Zusammenfassung

HINTERGRUND: Die Verbesserung der gesundheitsbezogenen Lebensqualität (gLQ) als Ergebnisparameter ist in der kardiologischen Rehabilitation noch wenig untersucht. Gerade das subjective Gesundheitsgefühl des Patienten ist aber ein entscheidender Endpunkt rehabilitativer Maßnahmen. Ziel der vorliegenden Studie war es, die Veränderung der gLQ nach einem kardialen Ereignis und während eines nachfolgenden Anschlussheilverfahrens in sechs österreichischen Rehabilitationszentren mit kardiologischem Schwerpunkt aus der Sicht der Patienten zu untersuchen. METHODE UND STICHPROBE: Bei 487 kardiologischen Rehabilitationspatienten (64,7% Männer, Alter 60,9 ± 12,5 Jahre) nach Myokardinfarkt ohne und mit perkutaner koronarer Intervention (PCI), nach aortokoronarer Bypassoperation (ACBP) und nach Herzklappenoperation (HKO) wurde eine Ergebnisanalyse durchgeführt. Alle Patienten mit kardiologischem Anschlussheilverfahren in den sechs Herz-Kreislauf-Rehabilitationszentren der PVA wurden eingeschlossen. Die kardiale Leistungsfähigkeit, das kardiale Risikoprofil und die subjektiv wahrgenommene Lebensqualität (MacNew Heart Disease Quality of Life Questionnaire [MacNew] und EuroQol-5D [EQ-5D]) wurden am Beginn und bei Abschluss des Rehabilitationsverfahrens erhoben. ERGEBNISSE: Die globale Lebensqualität (MacNew) hat sich über den Zeitraum der Rehabilitation significant verbessert (MacNew global: 0,75 ± 0,88 SD, T = −16,99, df = 394, p < .001) und war klinisch bedeutsam. Die Risikofaktoren Cholesterin, LDL-Cholesterin, Triglyceride, Bodymass-Index, Bauchumfang und Bluthochdruck wurden ebenfalls signifikant verbessert (alle p < .001). Die Lebensqualitätszuwächse von Patienten mit ACBP, HKO oder MI ohne nachfolgende PCI waren signifikant höher als bei jenen Patienten mit MI und PCI nach der stationären Rehabilitation (p < .02) ZUSAMMENFASSUNG: In der vorliegen Studie konnte gezeigt werden, dass durch eine stationäre Rehabilitation von Patienten nach einem kardialen Ereignis eine statistisch signifikante und klinisch bedeutsamen Verbesserung der gLQ erreicht werden kann. Diesem Ergebnisparameter sollte zukünftig mehr Bedeutung zuerkannt werden.

Summary

BACKGROUND: The goal of cardiac rehabilitation programs is not only to prolong life, but also to improve physical functioning, symptoms, wellbeing and health-related quality of life (HRQL). The aim of the study was to document short-term outcomes of cardiac rehabilitation programs in Austria. METHODS: Consecutive patients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction (MI), with or without percutaneous interventions (PCI), coronary artery bypass grafting (CABG) or heart valve surgery (HVS), referred to the six inpatient rehabilitation centers of the Austrian PVA insurance company, were included in the study. Exercise capacity, risk factors and HRQL (MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]) were measured at the beginning and end of the 4-week inpatient cardiac rehabilitation program. RESULTS: Global HRQL (MacNew) improved significantly over time in all patients combined (+0.75 ± 0.88 SD, T = −16.99, df = 394, p < .001) and exceeded the minimal important difference. Patients with CABG, HVS or MI without PCI showed the greatest improvements in global HRQL after cardiac rehabilitation (p < .02). Blood pressure, cholesterol, triglyceride, body mass index, waist circumference improved significantly (all p < .001). CONCLUSION: These findings provide evidence that the improvements in HRQL and risk factors following cardiac rehabilitation in Austria are clinically important. HRQL should become a standard outcome parameter in cardiac rehabilitation.

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Authors and Affiliations

  1. Medizin Universität Innsbruck, Univ.-Klinik für Medizinische Psychologie und Psychotherapie, Innsbruck, Austria

    Stefan Höfer

  2. Ludwig-Boltzmann-Institut für Rehabilitation interner Erkrankungen, Saalfelden, Austria

    Werner Kullich

  3. Pensionsversicherungsanstalt PVA, Hauptstelle chefärztlicher Bereich, Wien, Austria

    Ursula Graninger & Rudolf Müller

  4. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, St. Radegund, Austria

    Dieter Brandt

  5. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, Großgmain, Austria

    Alfred Gaßner

  6. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, Hochegg, Austria

    Martin Klicpera

  7. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, Bad Tatzmannsdorf, Austria

    Herbert Laimer

  8. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, Felbring, Austria

    Christiane Marko

  9. Sonderkrankenanstalt/Rehabilitationszentrum der PVA, Saalfelden, Austria

    Helmut Schwann

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  1. Stefan Höfer
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  2. Werner Kullich
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  3. Ursula Graninger
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  4. Dieter Brandt
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  5. Alfred Gaßner
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  7. Herbert Laimer
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  8. Christiane Marko
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  10. Rudolf Müller
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Correspondence to Stefan Höfer.

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Höfer, S., Kullich, W., Graninger, U. et al. Cardiac rehabilitation in Austria: short term quality of life improvements in patients with heart disease. Wien Klin Wochenschr 118, 744–753 (2006). https://doi.org/10.1007/s00508-006-0727-6

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  • DOI: https://doi.org/10.1007/s00508-006-0727-6

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