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ZusammenfassungIn der vorliegenden Studie wurde die Prävalenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5% der onkologischen und 4,5% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am häufigsten wurden 2-MRGN und ESBL (2,9%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Prävalenzraten für 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Prävalenzraten für multiresistente Krankenhauskeime.

Background Multi-component cardiac rehabilitation (CR) is performed to achieve an improved prognosis, superior health-related quality of life (HRQL) and occupational resumption through the management of cardiovascular risk factors, as well as improvement of physical performance and patients’ subjective health. Out of a multitude of variables gathered at CR admission and discharge, we aimed to identify predictors of returning to work (RTW) and HRQL 6 months after CR. Design Prospective observational multi-centre study, enrolment in CR between 05/2017 and 05/2018. Method Besides general data (e.g. age, sex, diagnoses), parameters of risk factor management (e.g. smoking, hypertension), physical performance (e.g. maximum exercise capacity, endurance training load, 6-min walking distance) and patient-reported outcome measures (e.g. depression, anxiety, HRQL, subjective well-being, somatic and mental health, pain, lifestyle change motivation, general self-efficacy, pension desire and self-assessment of the occupational prognosis using several questionnaires) were documented at CR admission and discharge. These variables (at both measurement times and as changes during CR) were analysed using multiple linear regression models regarding their predictive value for RTW status and HRQL (SF-12) six months after CR. Results Out of 1262 patients (54±7 years, 77% men), 864 patients (69%) returned to work. Predictors of failed RTW were primarily the desire to receive pension (OR = 0.33, 95% CI: 0.22–0.50) and negative self-assessed occupational prognosis (OR = 0.34, 95% CI: 0.24–0.48) at CR discharge, acute coronary syndrome (OR = 0.64, 95% CI: 0.47–0.88) and comorbid heart failure (OR = 0.51, 95% CI: 0.30–0.87). High educational level, stress at work and physical and mental HRQL were associated with successful RTW. HRQL was determined predominantly by patient-reported outcome measures (e.g. pension desire, self-assessed health prognosis, anxiety, physical/mental HRQL/health, stress, well-being and self-efficacy) rather than by clinical parameters or physical performance. Conclusion Patient-reported outcome measures predominantly influenced return to work and HRQL in patients with heart disease. Therefore, the multi-component CR approach focussing on psychosocial support is crucial for subjective health prognosis and occupational resumption. Trial registration The study was registered at the German Clinical Trial Registry and the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization (DRKS00011418; http://www.drks.de/DRKS00011418, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00011418).

Background In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results One hundred and thirty-six patients (80.6 ± 5.0 years, 47.8% male) were enrolled. 6MWD and maximum work load increased by 56.3 ± 65.3 m ( p 0.001) and 8.0 ± 14.9 watts ( p 0.001), respectively. An improvement in SF-12 (physical 2.5 ± 8.7, p = 0.001, mental 3.4 ± 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.

We investigated the prevalence of multidrug resistant pathogens in patients of oncologic and cardiologic rehabilitation units with 155 oncologic and 157 cardiologic patients undergoing microbiologic screening. It was found that 4.5% of oncologic as well as cardiologic patients were colonized with multidrug resistant pathogens. 2-MRGN and ESBL were the most encountered species (2.9%). 3-MRGN were found twice as frequent in oncologic patients (2.6 and 1.3%). Overall oncologic and cardiologic patients exhibit comparatively low prevalence rates for multidrug resistant pathogens.In der vorliegenden Studie wurde die Prävalenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5% der onkologischen und 4,5% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am häufigsten wurden 2-MRGN und ESBL (2,9%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Prävalenzraten für 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Prävalenzraten für multiresistente Krankenhauskeime.

AIM Complete postoperative heart block following open-heart surgery and sinus node dysfunction are indications for permanent cardiac pacing in children with congenital heart defects. The purpose of our study was to evaluate if cardiac pacing is a risk factor of heart failure during longtime follow-up of grown ups with congenital heart disease (GUCH). METHODS For an objective assessment of heart failure, NT-Pro brain natriuretic peptide (BNP) and maximal oxygen uptake index (VO2max) during the cardiopulmonary exercise testing were measured in 346 consecutive GUCH patients during a longtime follow-up examination. RESULTS Thirty-nine of these patients who had pacemaker implantation had significantly increased BNP levels (448.2 +/- 76.8 vs 123.8 +/- 9.7 pg/mL, P < 0.0001) and significantly decreased VO(2max) (22.5 +/- 0.9 vs 27.4 +/- 0.4, P < 0.0001). Heart failure in pacemaker patients was associated with significantly prolonged QRS complex durations (171.1 +/- 8.3 ms vs 108.7 +/- 1.8 ms, P < 0.0001), increased right ventricular end diastolic diameters (38.7 +/- 2.1 mm vs 27.8 +/- 0.5mm, P < 0.0001), lower heart rates at rest (69.5 +/- 1.9/min vs 82 +/- 1/min, P < 0.0001), and at exercise (140.3 +/- 5.8/min vs 163.5 +/- 1.2/min, P < 0.0001). Mean fractional shortening of the left ventricle was normal in both patient groups. CONCLUSION Pacemaker implantation may be associated with heart failure during longtime follow-up of GUCH indicated by significantly elevated BNP levels and decreased VO2max. Possible explanations are prolongation of QRS complex duration, decreased maximal heart rates during exercise, and dilatation of the right ventricle.