Cardiovascular Rehabilitation Overlooked

Letters to the Editor Intermittent Claudication and Asymptomatic Peripheral Arterial Disease Conservative Treatment Versus Revascularization by Prof. Dr. med. Gerhard Rümenapf, Dr. med. Stephan Morbach, PD Dr. med. Andrej Schmidt, and Dr. med. Martin Sigl in issue 11/2020

In their article, Rümenapf et al. describe the current evidence of conservative therapy as compared to intervention or surgery in patients with peripheral arterial disease (PAD) (1). Based on the guidelines of the German Society for Angiology on PAD (2), the randomized studies on this topic were identified as part of a systematic literature search.

The authors rightly state that supervised walking and training measures are “not currently implemented at all in the German health care system”—despite the very high level of evidence (IA). Unfortunately, they do not mention that supervised walking and lifestyle modification represent standardized and established parts of cardiovascular rehabilitation. According to the current S3 Guideline on cardiac rehabilitation, patients with PAD in the Fontaine stages IIa and IIb, stage IIb with complications (for example, after revascularization with unhealed wounds), and stage IIa after revascularization (percutaneous transluminal angioplasty [PTA] or surgery) should participate in rehabilitation (3).

Rehabilitation of patients with PAD aims to improve peripheral blood flow and to reduce cardiovascular morbidity and mortality, as well as to avoid amputations. In addition, the patient´s quality of life is improved by extending the pain-free walking distance, thereby enabling social and professional participation (ability to commute to work) (3). The effect of supervised walking and vascular training as well as the support and continuation of secondary prevention as part of a rehabilitation measure has been scientifically proven (3).

DOI: 10.3238/arztebl.2020.0676b

Prof. Dr. med. Axel Schlitt, MHA
Abteilung 1, Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg, Germany

Dr. med. Gesine Dörr
Klinik für Innere Medizin
Alexianer St. Josef Potsdam GmbH, Potsdam, Germany

 Prof. Dr. med. Bernhard Schwaab
Prof. Schwaab ist Präsident der Deutschen Gesellschaft für Prävention und
Rehabilitation von Herz-Kreislauferkrankungen e. V. (DGPR)
Curschmann Klinik, Timmendorfer Strand, Germany

Conflict of interest statement
The authors declare that no conflict of interest exists.

References

1. Rümenapf G, Morbach S, Schmidt A, Sigl M: Intermittent claudication and asymptomatic peripheral arterial disease—conservative treatment versus revascularization. Dtsch Arztebl Int 2020; 117: 188–93

2. Lawall H, Huppert P, Espinola-Klein C, Rümenapf G: Clinical practice guideline: The diagnosis and treatment of peripheral arterial vascular disease. Dtsch Arztebl Int 2016; 113: 729–36

3. AWMF: S3-Leitlinie Kardiologische Rehabilitation im deutschsprachigen Raum Europas (D-A-CH). Register-Nr. 133–01; https://www.awmf.org/leitlinien/detail/ll/133-001.html (last accessed on 7 May 2020).