Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.

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.

Background: While the relationship between recent dental treatment and the development of endocarditis is largely undisputed, the relationship between poor dental status and the development of infective endocarditis has not yet been proven beyond doubt. We have therefore analyzed this hypothetical connection using our established endocarditis register (B.E.R.). Patients and Methods: A total of 72 patients who underwent dental treatment (TREAT) and 55 patients with a desolate dental status (DESOLATE) were found in our database of 530 patients subsequently developing infective endocarditis necessitating valve surgery. A propensity score analysis was performed comparing TREAT as well as DESOLATE with matched patients without these conditions as CONTROL. Results: TREAT showed significantly more often Strept. mitis (26.9%) as well as other Streptococci (36.54%, p = 0.001) compared to CONTROL (3.51% and 10.53%, respectively), whereas Staphylococci and E. faecalis were found more often in CONTROL than in TREAT (S. aureus: 22.81% vs. 15.38%, n.s.; other Staphylococci 14.04% vs. 1.92%, p = 0.033; E. faec.: 26.32% vs. 9.62%, p = 0.045). DESOLATE showed significantly more Strept. mitis compared to CONTROL (27.91% vs. 4.88%, p = 0.007). Early mortality was 23.7% in the TREAT group, while it was 15.25% in the CONTROL group and 17.02% in the DESOLATE group vs. 20.83% in the CONTROL patients. Conclusions: The current results suggest that adequate endocarditis prophylaxis to prevent bacteremia may not be carried out in patients undergoing dental treatment and may occur spontaneously in patients with poor dental care. Both situations require new strategies to avoid such severe consequences.

Patienten mit pAVK sind hinsichtlich der Verordnungshäufigkeit von Reha-Maßnahmen [1] und der Kontrolle der Risikofaktoren im Vergleich zu Patienten mit koronarer Herzerkrankung (KHK) bei Hausärzten schlechter eingestellt [2–4]. Sie erkennen das erhöhte kardiovaskuläre Risiko und die damit verbundene Notwendigkeit einer Lebensstiländerung und Therapietreue nicht in dem Maße wie Patienten mit KHK [5]. Dieser Beitrag widmet sich der Frage, warum die Entwicklung spezialisierter gefäßmedizinischer Versorgungsstrukturen angestrebt wurde und wie sich dies zu einem eigenständigen Gebiet der Rehabilitation weiterentwickeln kann und sollte.

Patienten mit pAVK sind hinsichtlich der Verordnungshäufigkeit von Reha-Maßnahmen 1 und der Kontrolle der Risikofaktoren im Vergleich zu Patienten mit koronarer Herzerkrankung (KHK) bei Hausärzten schlechter eingestellt 2 3 4. Sie erkennen das erhöhte kardiovaskuläre Risiko und die damit verbundene Notwendigkeit einer Lebensstiländerung und Therapietreue nicht in dem Maße wie Patienten mit KHK 5. Dieser Beitrag widmet sich der Frage, warum die Entwicklung spezialisierter gefäßmedizinischer Versorgungsstrukturen angestrebt wurde und wie sich dies zu einem eigenständigen Gebiet der Rehabilitation weiterentwickeln kann und sollte.