Wirksame und wirtschaftliche kardiale Rehabilitation: wissenschaftliche und konzeptionelle Grundlagen

Comprehensive cardiac rehabilitation. At present there are several activities on the level of a particular canton or of some cantons in common to obtain an integrated care of patients with chronical diseases including delivery of acute care and medical rehabilitation. These activities are commissioned by the health departments and include also patients with heart diseases. This article is part of such activities and can be seen as a health policy statement. The article addresses the role of cardiac rehabilitation and the potential benefits to be derived from comprehensive care of patients with coronary heart disease. Extensive literature searches were conducted to evaluate scientific evidence and significant outcomes. The results highlight the major effects of multifactorial long-term services involving medical evaluation, exercise training, nutrition counselling, cardiac risk factor modification and education, counselling and behavioral interventions. This multifactorial process is designed to limit the adverse physiologic and psychological effects of cardiac illness, reduce the risk of sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the patient's psychosocial and vocational status. Economic evaluations suggest that comprehensive cardiac rehabilitation is a cost-effective use of medical care resources. At relatively low costs, clinical benefits are attained and economic outcome is favorable. The conceptual recommendations for cardiac rehabilitation services in Switzerland are based on these results. Future approaches to the delivery of cardiac rehabilitation services are presented differing between several in-patient and outpatient programs, which are related to different categories of patients with special needs e.g. because of their postoperative state, polymorbidity or functional dependence. At present there are several activities on the level of a particular canton or of some cantons in common to obtain an integrated care of patients with chronical diseases including delivery of acute care and medical rehabilitation. These activities are commissioned by the health departments and include also patients with heart diseases. This article is part of such activities and can be seen as a health policy statement. The article addresses the role of cardiac rehabilitation and the potential benefits to be derived from comprehensive care of patients with coronary heart disease. Extensive literature searches were conducted to evaluate scientific evidence and significant outcomes. The results highlight the major effects of multifactorial long-term services involving medical evaluation, exercise training, nutrition counselling, cardiac risk factor modification and education, counselling and behavioral interventions. This multifactorial process is designed to limit the adverse physiologic and psychological effects of cardiac illness, reduce the risk of sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the patient's psychosocial and vocational status. Economic evaluations suggest that comprehensive cardiac rehabilitation is a cost-effective use of medical care resources. At relatively low costs, clinical benefits are attained and economic outcome is favorable. The conceptual recommendations for cardiac rehabilitation services in Switzerland are based on these results. Future approaches to the delivery of cardiac rehabilitation services are presented differing between several in-patient and outpatient programs, which are related to different categories of patients with special needs e.g. because of their postoperative state, polymorbidity or functional dependence.