Via practica 3/2018

Vybrané kazuistiky ambulantnej kardiovaskulárnej rehabilitácie/sekundárnej prevencie

Selected case reports of outpatient cardiovascular rehabilitation/secondary prevention Cardiovascular diseases, mainly coronary heart disease (CAD), are still at the first stage as for total mortality causes. A lot of years we can see a great development in pharmacological treatment of CAD and in sophisticated diagnostic and treatment procedures. For this reason, almost every patient could survive acute coronary event but a lot of patients suffer as chronic CAD continuing. In this regard appears the opportunity to apply cardiovascular rehabilitation which has the significant positive effect in patients after myocardial infarction and coronary revascularization. CAD is preventable disease as a whole, it´s prognosis could be influenced by early diagnosis, proper management and cardio-rehabilitation/secondary prevention procedures. Study IMPACT Model (2011) showed in years 1987 – 2007 48 % CAD mortality decrease in the world as a whole. This effect is considered in 60 % as an effect of preventative procedures including cardio-rehabilitation/secondary prevention and in 40 % as an effect of improving therapeutic modalities. The complex cardiovascular rehabilitation/secondary prevention (CCVR/SP) is assessed as for as effectivity at patients with coronary events in the evidence-based medicine (EBM) scale as class I A. CCVR/SP is a multifactorial and multifunctional method for patients suffering from cardiovascular diseases to enable them to return to the previous performance and to help them to reach the optimal physical, psychological, social and emotional conditions. Programs of the CCVR/SP should include specific components, the most significant among them is exercise-physical training. There is confirmed that working muscles during exercise produce myokines which are molecules with autocrine, paracrine and endocrine effects. Through- -out these biological mechanisms they are able to influence not only cardiovascular system but a lot of chronical disease too. Myokines have got a big potential to bring benefit in the treatment of diseases with chronic inflammation in the background. In spite of strong evidence of CCVR/SP positive effect are these programs for out-patients underestimated. Mainly in the countries with high CAD mortality including Slovakia. Authors want to emphasis the absence of practical implementation CCVR/SP for out-patients by responsible institution for health care system in Slovakia as a main obstacle. By some case reports we would like to initiate the physician´s interest in CCVR/SP and to present clinical effects of regular cardio-trainings. In spite of valid guidelines of specialized medical societies is the participation in CCVR/SP very weak. Non-participation in the CCVR/SP after acute coronary events should be today considered as a more than suboptimal treatment.

Keywords: complex cardiovascular rehabilitation for outpatients, components cardio-training, myokines, implementation