[Effect of optimized integrated management on long-term effectiveness of cardiologic rehabilitation]. / Einfluss eines optimierten Schnittstellenmanagements auf die Langzeiteffektivität der kardiologischen Rehabilitation.

BACKGROUND AND OBJECTIVE: Long-term risk factor (RF) modification after cardiac rehabilitation (CR) is less than satisfactory. Problems of communication between the CR centre and the practising physician (GP) are one potential source of sub-optimal management. The goal of the PROTECT-study was to evaluate the influence of improved communication between rehabilitation centres and the GP on the quality of RF-modification. PATIENTS AND METHODS: In 50 specialized CR centres 882 patients in the group with intensified communication were compared to 160 patients in the usual care group. All patients underwent a course of residential CR. Intensified communication was attempted by a total of four phone calls to the GP, a RF booklet in which the RF profile, the individual RF treatment goals and the current RF status were delineated. Main treatment goals with respect to RF-modification after 6 months were: Blood pressure < 140/90 mmHg, LDL-Cholesterol < 100 mg/dl or at least 115 mg/dl and a body mass index of < 25 or at least < 30. RESULTS: The percentage of of patients with adequate blood pressure control (< 140/90 mmHg) was 85.1% vs. 85%, with LDL-cholesterol < 100 mg/dl 27.2% vs. 23.9%, with good body-mass index (< 25) 32.4% vs. 28.2% (intensified communication vs. control group; p = ns). The treatment initiated by the CR centres was continued in about 90% of patients. CONCLUSION: The study has shown that improved communication between the CR centres and the GP's after CR had only a marginal effect on the quality of RF-management. One key element of secondary prevention could be to get the patient more strongly involved in reaching the targets of therapy.

[Blood volume displacement under oral dihydroergotamine during orthostatic strain (author's transl)]. / Blutvolumen-verlagerung während orthostatischer Belastung unter oral appliziertem Dihydroergotamin.

During the course of a double-blind study in 30 orthostatically unstable adolescent subjects, the effect of oral dihydroergotamine (DHE) on the orthostatic circulatory regulation was examined. During standardized orthostatic strain the volume of blood sinking into the two legs is statistically significantly reduced to 125 +/- 61 ml (29%) under the influence of DHE after standing for only 11 sec. Furthermore, there is a significant reduction of the maximal arterial influx into the lower extremities as well as the resting heart rate and the maximal heart rate during orthostatic strain. No significant changes could be detected in the placebo group. Consequently, DHE is suitalbe for the treatment of the these disturbances of orthostatic circulatory regulation due to increased elasticity of the capacitive vessels in the lower extremities.