RESUMEN
INTRODUCTION: There are hardly any publications about the outcome of cardiac rehabilitation considering patients with an increased need for medical, nursing and therapeutic care. The aim of this study, which consecutively included n=387 statutory health insurance inpatients over a period of 2 years, was to find out differences in outcome in self-care patients (Barthel index>70) as compared to patients with a need for complex care (Barthel index≤70). METHODS: Rehabilitation outcomes concerning physical capacity, emotional status and activities of daily living as measured by Barthel index, FIM index, HADS, clinical complications, exercise test, duration of rehabilitation and form of dismission were analyzed and compared between both groups. RESULTS: The inpatients with a Barthel index ≤70 at admission were older, had a longer stay in hospital and in rehabilitation, developed more complications and more often suffered from concomitant diseases. They were readmitted to hospital more often. They showed a comparatively higher increase in indices of self-care and a significant increase in physical performance tests. CONCLUSION: Higher medical care expenses of multimorbid cardiac inpatients are no contraindication against rehabilitation, because even in this group the specific rehabilitation aims of the healthcare payers can be reached.
Asunto(s)
Actividades Cotidianas/psicología , Rehabilitación Cardiaca/psicología , Rehabilitación Cardiaca/estadística & datos numéricos , Personas con Discapacidad/psicología , Personas con Discapacidad/rehabilitación , Autocuidado/estadística & datos numéricos , Anciano , Personas con Discapacidad/estadística & datos numéricos , Tolerancia al Ejercicio , Femenino , Alemania/epidemiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Admisión del Paciente/estadística & datos numéricos , Prevalencia , Pronóstico , Estudios Retrospectivos , Autocuidado/psicología , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the ability of conventional and Doppler echocardiography to distinguish between minor, acute massive, and subacute massive pulmonary embolism in patients with confirmed pulmonary embolism. DESIGN: Prospective study of a consecutive series of 47 patients with confirmed pulmonary embolism. SETTING: Department of internal medicine, university clinic. PATIENTS: 11 patients (23%) had minor, 23 patients (49%) had acute massive, and 13 patients (28%) had subacute massive pulmonary embolism. RESULTS: Dilatation of the right ventricular cavity (33 (92%)) and asynergy of the right ventricular free wall (29 (81%)) were seen only in patients with acute and subacute massive pulmonary embolism (n = 36). 23 (64%) with pulmonary hypertension had tricuspid regurgitation. The velocity of the tricuspid regurgitant jet correlated with the pulmonary arterial pressure (r = 0.88, SEE = 11.6 mm Hg) and was significantly lower in patients with acute massive pulmonary embolism (3.0 (0.4) m/s, n = 12) than in patients with subacute massive pulmonary embolism (4.2 (0.6) m/s; n = 11) (p < 0.001). The use of predefined indices (right ventricular free wall thickness > 5 mm; tricuspid regurgitant jet velocity > 3.7 m/s; and the occurrence of both a dilated right ventricular cavity with normal interventricular septal motion, or an inspiratory collapse of the inferior vena cava, or both) correctly identified 11 of 13 patients (85%) with subacute massive pulmonary embolism. CONCLUSION: Conventional and Doppler echocardiography were successful in evaluating the haemodynamic consequences of pulmonary embolism.
Asunto(s)
Ecocardiografía , Embolia Pulmonar/diagnóstico por imagen , Enfermedad Aguda , Presión Sanguínea/fisiología , Cateterismo Cardíaco , Gasto Cardíaco/fisiología , Ecocardiografía Doppler , Femenino , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/fisiopatología , Resistencia Vascular/fisiologíaRESUMEN
Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) at a dosage of 40-150 mg was given to five patients with acute and five with recurrent pulmonary emboli (three women and seven men; mean age 54 [30-78] years). Mean pulmonary artery pressure fell from 29 +/- 7 mm Hg before to 20 +/- 5 mm Hg after treatment (P = 0.001), and in recurrent emboli from 47 +/- 19 to 18 +/- 10 mm Hg (P = 0.01). Pulmonary vascular resistance fell from 546 +/- 262 to 318 +/- 116 dyn.s.cm-5 (P = 0.02) in the former group and from 993 +/- 583 to 377 +/- 438 dyn.s.cm-5 (P = 0.01) in the latter. Pulmonary arteriograms were assessed using the Miller index. This indicated a drop from an average of 23 points before to an average of 10.5 points after treatment. Mild bleedings occurred in all patients, but in two it was severe enough to require discontinuation of treatment. These results demonstrate that rt-PA is highly effective as a thrombolytic agent in acute and in subacute recurrent pulmonary embolism.