Several studies have investigated the difficulties of systematically implementing guidelines in routine clinical practice. This is the very reason why Deutsches Ärzteblatt decided on commissioning this type of article. Our CME article aimed to point out a possible pathway to readers.
Still, our article should be seen merely as a recommendation—just like guidelines themselves. The treating physician needs to consider the risks and benefits of diagnostic cardiac catheterization individually for each patient.
The suggestion made by our colleagues from the department of sports medicine at Tübingen University to use treadmill testing rather than the exercise bike is certainly a good alternative. The same can be said for the combination with lactate diagnosis and/or spiro-ergometry. However, it needs to be borne in mind that these methods are not available everywhere.
We agree that professional support to help patients learn to cope with their illness, including influencing lifestyles and modifying risk profiles, is important.
The German Disease Management Guidelines (1) recommend that multidisciplinary rehabilitation be undertaken after acute ST elevation myocardial infarction and non-ST-elevation myocardial infarction, after coronary bypass surgery, and, in selected cases, after elective percutaneous coronary artery intervention (PCI), for example, in patients with a pronounced risk profile, where the requirement for training is high, or where compliance is a problem. However, the effect of multidisciplinary rehabilitation in patients after non-ST-elevation myocardial infarction and after PCI has not been studied to a satisfactory degree (1).
After PCI, patients are most likely to benefit with regard to lifestyle adjustments, physical performance, and professional rehabilitation. However, they should be technically and professionally monitored during this process.
Prof Dr. med. Tienush Rassaf
Prof Dr. med. Malte Kelm
Klinik für Kardiologie, Pneumologie, Angiologie
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists
|1.||Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF): Nationale VersorgungsLeitlinie Chronische KHK – Langfassung. Version 1.X. 2006. Available from: www.khk.versorgungsleitlinien.de DOI: 10.6101/AZQ/000041 Last accessed on 15. May 2013.|
|2.||Rassaf T, Steiner S, Kelm M: Postoperative care and follow up after coronary stenting. Dtsch Arztebl Int 2013; 110(5): 72–82. VOLLTEXT|