Rehabilitation Measures as Therapeutic Cornerstones
The background and results sections of the abstract point out that most patients can return to their everyday routine a few days after a successful percutaneous coronary intervention (PCI).
The section of learning objectives also creates the impression that coronary heart disease is an accident that heals completely after successful therapy using PCI and appropriate, close, medical, and diagnostic aftercare as long as all the rules of the art of medicine are adhered to and much time and effort are expended in order to ensure compliance with the treatment and follow-up examinations.
The section of recommended clinical patient follow-up by primary care physicians and cardiologists suggests conducting clinical, apparatus-based diagnostic evaluation as well as motivating patients to change their lifestyles.
What is not mentioned even in a single word is professional support, which is crucial to help patients learn to cope with their illness (1); this includes influencing lifestyles and modifying risk factor profiles in the context of an indicated follow-up cardiac rehabilitation therapy that is covered by the health insurance companies.
In most hospitals and doctors’ minds it takes a contracted injury to the heart (myocardial infarction, the larger the better) or bypass surgery in order to prompt thoughts of cardiac rehabilitation measures.
In this respect, our health insurers are more advanced than those acting at the coalface of acute care. For years, successful coronary intervention has been an acceptable indication for health insurers to cover the cost of subsequent rehabilitation therapy (2), with corresponding successes in the long-term prognosis and avoidance of repeated morbidity (3).
This fact has not become anchored in the minds of specialists in acute medicine; this article yet again shows that no mention is made of the fact that—in addition to medication, cardiac catheterization, coronary computed tomography scanning, magnetic resonance imaging, and stress echocardiography—cardiac rehabilitation should be one of the cornerstones of the therapy provided to patients after PCI.
Dr. med. Markus Zirbes
Dr. med. Brigitte Buran-Kilian
Dr. med. Thomas Aupperle
Schwerpunktpraxis, Ambulante kardiale Rehabilitation, Bonn
|1.||Buss U, Herrmann-Lingen C: Der Prozess der Krankheitsbewältigung. In: Rauch B, et al. (eds): Kardiologische Rehabilitation, Standards für die Praxis nach den Leitlinien der Deutschen Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen-DGPR. Stuttgart Thieme Verlag 2007; 122–34.|
|2.||Bundesarbeitsgemeinschaft für Rehabilitation – Schriftenreihe der Bundesarbeitsgemeinschaft für Rehabilitation: Arbeitshilfe zur Rehabiltiation Koronarkranker, Stand 17. Juni 1997, S. 61 ff. www.bar-frankfurt.de/fileadmin/dateiliste/publikationen/arbeitshilfen/downloads/Arbeitshilfe_Koronar.pdf. Last accessed on 14 May 2013.|
|3.||Korsukéwitz C, Falk J, Lindow B: Kardiologische Rehabilitation in Deutschland. Herz 2012; 37: 12–21. CrossRef MEDLINE|
|4.||Rassaf T, Steiner S, Kelm M: Postoperative care and follow up after coronary stenting. Dtsch Arztebl Int 2013; 110(5): 72–82.|