THE PROBLEMS OF HEALTH CARE DELIVERY TO PATIENTS WITH LONG-LASTED CARDIAC INSUFFICIENCY IN GERMANY
Health care delivery for cardiac insufficiency is a specific problem both from clinical and economical points of view. Practical realization of new treatment methods, that influence positively on the run of the disease, appear insufficient. Whereas current trainings lead to substantial reduction of referrals to hospital treatment and therefore cost reduction, there has not been a long-term complex rehabilitation program for such patients so far. We are planning to conduct individual programs under the supervision of expert sport medicine specialists. It is well-known that aerobic endurance training of patients with long-lasted cardiac insufficiency on condition far gone stage of disease (e.g. with maximum oxygen consumption of <20 мl/kg/мin) does not only improve the quality of life and forecast, but also let raise the capacity to bear of physical exertion at 12-20%. In case of decrease the capacity to bear physical stress and/or in case of advanced age the initial loading should be 30% of maximum voluntary contraction (MVC), and if patients bear the load well, the initial level of loading could be up to 50% of MVC. After having finished power-endurance training successfully (from 12 to 25 repetitions at 30-50% of maximum power; 2-3 times a week for 4-6 weeks), patients could come to longer lasting, more often and intensive trainings. The article is devoted to the problems of health care delivery to patients suffering with long-lasted cardiac insufficiency in Germany. The article gives modern training recommendations for such patients.