Heart Failure Treatment in Integrated Care Models According to </n> 140 SGB V

Zusammenfassung Deutschlandweit werden uber 20.000 Patienten in integrierten Herzinsuffizienz-Versorgungsmodellen betreut (Bundesverband Niedergelassener Kardiologen, personliche Kommunikation, 16. Juli 2020). Durch eine damit einhergehende, leitliniengerechte Pharmakotherapie und regelma ss ige Kontrolluntersuchungen lasst sich die Lebensqualitat von herzinsuffizienten Patienten deutlich verbessern. Daruber hinaus lassen sich Krankenhauseinweisungen und daraus resultierend Kosten fur die Krankenversicherungen minimieren. Eine enge Kooperation (in einem Netzwerk) zwischen Klinikkardiologen, niedergelassenen Kardiologen und Hausarzten ermoglicht eine optimale Herzinsuffizienz-Behandlung in allen Herzinsuffizienz-Schweregraden. Integrierte Versorgungmodelle wie CorBene oder KardioExpert tragen dazu bei, neben einer optimalen Patientenbetreuung, wissenschaftliche Auswertungen vorzunehmen und harte Endpunkte wie Re-Hospitalisierung oder kardiovaskulare Mortalitat zu reduzieren. Das hier vorgestellte KHAD-Modell (Kolner Herzen Atmen durch) ist ein integriertes Versorgungsmodell in dem die aktuellen Leitlinienempfehlungen zur poststationaren Versorgung von Herzinsuffizienzpatienten in der Region Koln umgesetzt werden sollen. Fast allen Krankenkassen unterstutzen das Modell. Es nehmen alle Kolner Krankenhauser und einige der niedergelassenen Kolner Kardiologen teil, um eine optimale Herzinsuffizienz-Versorgung gewahrleisten zu konnen. Solche Modelle fur eine Herzinsuffizienz-Betreuung konnten in allen deutschen Gro ss stadten praktiziert werden. Zum Wohle der Patienten, zur Einsparung von Potenzialen bei den Krankenkassen, fur eine angemessene Honorierung der behandelnden Arzte und zur Entlastung der Krankenhauser - ein Gewinn fur unsere Patienten und alle Beteiligten im Gesundheitssystem. Abstract Across Germany, more than 20,000 patients are cared for in integrated heart failure care models (Federal Association of General Practitioners of Cardiology, personal communication, 16 July 2020). The quality of life of patients with heart failure can be significantly improved by means of pharmacotherapy in accordance with guidelines and regular check-ups. In addition, hospital admissions and the resulting costs for health insurance companies can be minimised. Close cooperation (in a network) between clinical cardiologists, cardiologists in private practice and general practitioners enables optimal heart failure treatment in all degrees of heart failure. Integrated care models such as CorBene or KardioExpert contribute to optimal patient care, scientific evaluations and the reduction of hard endpoints such as re-hospitalisation or cardiovascular mortality. The KHAD model Kolner Herzen Atmen durch presented here is an integrated care model in which the current guidline recommendations for post-inpatient care of heart failure patients in the Cologne region are implemented. The model is supported by almost all health insurance companies. All Cologne hospitals and some of the Cologne cardiologists in private practice participate in order to ensure optimal heart failure care. Such models for heart failure care could be practised in all major German cities. For the benefit of the patients, for saving potential with the health insurance companies, for an appropriate remuneration of the attending physicians and to relieve the hospitals - a benefit for our patients and all those involved in the health system

Substantial improvement of primary cardiovascular prevention by a systematic score-based multimodal approach: A randomized trial: The PreFord-Study

Trial design Prospective randomized multicentre interventional study. Methods Individual cardiovascular risk assessment in Ford Company, Germany employees (n=4.196), using the European Society of Cardiology-Systematic Coronary Risk Evaluation (ESC-SCORE) for classification into three risk groups. Subjects assigned to ESC high-risk group (ESC-SCORE5%), without a history of cardiovascular disease were eligible for randomization to a multimodal 15-week intervention programme (INT) or to usual care and followed up for 36 months. Objectives Evaluation of the long-term effects of a risk-adjusted multimodal intervention in high-risk subjects. Primary endpoint: reduction of ESC-SCORE in INT versus usual care. Secondary endpoints: composite of fatal and non-fatal cardiovascular events and time to first cardiovascular event. Statistical analysis: intention-to-treat and per-protocol analysis. Results Four hundred and forty-seven subjects were randomized to INT (n=224) or to usual care (n=223). After 36 months ESC-SCORE development favouring INT was observed (INT: 8.70% to 10.03% vs. usual care: 8.49% to 12.09%; p=0.005; net difference: 18.50%). Moreover, a significant reduction in the composite cardiovascular events was observed: (INT: n=11 vs. usual care: n=27). Hazard ratio of intervention versus control was 0.51 (95% confidence interval 0.25-1.03; p=0.062) in the intention-to-treat analysis and 0.41 (95% confidence interval 0.18-0.90; p=0.026) in the per-protocol analysis, respectively. No intervention-related adverse events or side-effects were observed. Conclusions Our results demonstrate the efficiency of identifying cardiovascular high-risk subjects by the ESC-SCORE in order to enrol them to a risk adjusted primary prevention programme. This strategy resulted in a significant improvement of ESC-SCORE, as well as a reduction in predefined cardiovascular endpoints in the INT within 36 months. (ISRCTN 23536103.

Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2

Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for distress management and lifestyle changes. PE is able to increase patients' knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients' groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively