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ZusammenfassungDie European Society of Cardiology (ESC) hat 2018 nach 9 Jahren eine neue Leitlinie zur Diagnostik und Therapie von Synkopen publiziert. Neue Aspekte umfassen Risikostratifizierungs- und Entscheidungsstrategien in der... more
ZusammenfassungDie European Society of Cardiology (ESC) hat 2018 nach 9 Jahren eine neue Leitlinie zur Diagnostik und Therapie von Synkopen publiziert. Neue Aspekte umfassen Risikostratifizierungs- und Entscheidungsstrategien in der initialen Notaufnahmeabklärung, eine Neubewertung diagnostischer Verfahren (u. a. weitere Stärkung des implantierbaren Loop-Rekorders [ILR] bei ungeklärter Synkope, Kipptischuntersuchung als Bestätigungs-, nicht jedoch Suchtest), Algorithmen zur Therapie von Reflexsynkopen, ICD(implantierbarer Kardioverter-Defibrillator)-Indikationen bei Hochrisikokonstellationen für plötzlichen Herztod sowie neue Versorgungsstrukturen mittels interdisziplinärer Synkopeneinheiten. Die neue ESC-Leitlinie ist eine exzellente, detaillierte Anleitung zur sicheren, effektiven und effizienten Abklärung und Therapie von Patienten mit Synkopen. Dieser Kommentar diskutiert kritisch u. a. die ESC-Empfehlungen zur Karotissinusmassage, zur Abfolge diagnostischer Verfahren bei ungeklärten schweren, wiederholten, unvorhersehbaren Synkopen sowie zur Organisationsform von Synkopeneinheiten. Die in Deutschland unzureichende Verfügbarkeit und Vergütungssituation entscheidender diagnostischer Verfahren wie Kipptischuntersuchung und insbesondere ILR werden betont.AbstractIn 2018 the European Society of Cardiology (ESC) published after 9 years a new version of the guidelines for the diagnosis and management of syncope. New aspects include risk stratification and decision strategies during the initial evaluation in the emergency department, a reconsideration of diagnostic tests, e. g. strengthened role of an implantable loop recorder (ILR) in unexplained syncope, the tilt table test as a confirmation but not a screening test, algorithms for treatment of reflex syncope, indications for implantable cardioverter defibrillator (ICD) in patients with a high risk constellation for sudden cardiac death and new organizational aspects, such as interdisciplinary syncope units. The new ESC guidelines provide excellent and comprehensive instructions for a safe, effective and efficient evaluation and treatment of patients with syncope. These comments critically discuss the ESC recommendations for carotid sinus massage, the proposed sequence of diagnostic procedures in unexplained severe, recurrent, unpredictable syncope and the organizational aspects of syncope units. The inadequate availability and reimbursement of pivotal diagnostic tests in Germany, such as the tilt table test and notably ILR are emphasized.
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The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and... more
The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.
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Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the... more
Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.
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Big data and applications of artificial intelligence (AI), such as machine learning or deep learning, will enrich healthcare in the future and become increasingly important. Among other things, they have the potential to avoid unnecessary... more
Big data and applications of artificial intelligence (AI), such as machine learning or deep learning, will enrich healthcare in the future and become increasingly important. Among other things, they have the potential to avoid unnecessary examinations as well as diagnostic and therapeutic errors. They could enable improved, early and accelerated decision-making. In the article, the authors provide an overview of current AI-based applications in cardiology. The examples describe innovative solutions for risk assessment, diagnosis and therapy support up to patient self-management. Big data and AI serve as a basis for efficient, predictive, preventive and personalised medicine. However, the examples also show that research is needed to further develop the solutions for the benefit of the patient and the medical profession, to demonstrate the effectiveness and benefits in health care and to establish legal and ethical standards.
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Sustained monomorphic ventricular tachycardia is a potentially life-threatening ventricular tachycardia. The arrhythmia can be treated with antiarrhythmic drugs, when the patient is hemodynamically stable. Class IC antiarrhythmic drugs... more
Sustained monomorphic ventricular tachycardia is a potentially life-threatening ventricular tachycardia. The arrhythmia can be treated with antiarrhythmic drugs, when the patient is hemodynamically stable. Class IC antiarrhythmic drugs like flecainide and propafenon or ajmaline (class IA/IC) are very effective. The use of lidocaine is obsolete. Sotalol is also effective, however, caution is advised because of its significant beta-sympatholytic properties. Amiodaron is frequently used, although it has never been studied in the setting of stable ventricular tachycardia. Earlier studies have demonstrated that it is effective in the treatment of recurrent, hemodynamically unstable ventricular tachycardia. When a particular drug does not terminate tachycardia, further drugs should not be given. Electrical cardioversion is preferred
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The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac... more
The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac arrhytmia or increased risk of sudden cardiac death. The following article summarizes the possibilities of telemonitoring from a technical and organizational point of view and descibes basic requirements on SOPs. these basic requirements should be further specified and anchored in the organizational structure of the individual telemonitoring concept. Moreover, they should de understood as a basic guideline fpr the actions of telemonitoring center (TMC) employees.
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Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the... more
Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the imbalance between the need for treatment and the provision of care is growing. Telemonitoring/telemedicine offers patients in rural or remote areas access to high-quality health care and enables fast access to specialists. The working group 33 Telemonitoring of the German Cardiac Society describes the characteristics and possible applications of telemonitoring/telemedicine in the treatment of patients with heart failure. Furthermore, quality criteria for cardiological telemedicine centres are defined. In addition to the personnel structure of a telemedicine centre and the competencies of employees, requirements for the technical infrastructure and the management of incoming data and alarms are described.
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Hintergrund: Wie wir aus einer ersten Voruntersuchung im Rahmen des Berliner Herzinfarktregisters (BHIR) wissen, beeinflusst die erstversorgende Instanz mit der resultierenden Kommunikation zwischen Rettungsdienst (RD) und Klinik und die... more
Hintergrund: Wie wir aus einer ersten Voruntersuchung im Rahmen des Berliner Herzinfarktregisters (BHIR) wissen, beeinflusst die erstversorgende Instanz mit der resultierenden Kommunikation zwischen Rettungsdienst (RD) und Klinik und die Eindeutigkeit der Erstdiagnose auf der Basis des EKGs bei Infarktpatienten[zum vollständigen Text gelangen Sie über die oben angegebene URL]
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Hintergrund: Bei einem Myokardinfarkt mit ST-Streckenhebung im EKG (STEMI) spielt die qualifizierte und schnelle Notfallerstversorgung eine herausragende Rolle. Aus diesem Grund werden die europäischen Leitlinienempfehlungen der ESC für... more
Hintergrund: Bei einem Myokardinfarkt mit ST-Streckenhebung im EKG (STEMI) spielt die qualifizierte und schnelle Notfallerstversorgung eine herausragende Rolle. Aus diesem Grund werden die europäischen Leitlinienempfehlungen der ESC für STEMI-Patienten zunehmend ambitionierter formuliert. [zum vollständigen Text gelangen Sie über die oben angegebene URL]
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predictors of chronic left ventricular reduction in size by cardiac resynchronization therapy
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Long-term clinical effects of ventricular pacing reduction with a changeovermode tominimize ventricular pacing in a general pacemaker population
Background Maintaining mobility in old age is crucial for healthy ageing including delaying the onset and progress of frailty. However, the extent of an individuals´ mobility relies largely on their personal, social, and environmental... more
Background Maintaining mobility in old age is crucial for healthy ageing including delaying the onset and progress of frailty. However, the extent of an individuals´ mobility relies largely on their personal, social, and environmental resources as outlined in the Life-Space Constriction Model. Recent studies mainly focus on facilitating habitual out-of-home mobility by fostering one type of resources only. The MOBILE trial aims at testing whether tablet-assisted motivational counselling enhances the mobility of community-dwelling older adults by addressing personal, social, and environmental resources. Methods In the MOBILE randomized controlled trial, we plan to enrol 254 community-dwelling older adults aged 75 and older from Havelland, a rural area in Germany. The intervention group will receive a tablet-assisted motivational counselling at the participant´s home and two follow-up telephone sessions. Main focus of the counselling sessions lays on setting and adapting individual mo...
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Hintergrund: Durch Beschleunigung der koronaren Reperfusion und verbesserte medikamentöse Begleittherapie ist es in den vergangenen zwei Jahrzehnten gelungen, die Krankenhaussterblichkeit bei akutem Herzinfarkt deutlich zu senken. Die... more
Hintergrund: Durch Beschleunigung der koronaren Reperfusion und verbesserte medikamentöse Begleittherapie ist es in den vergangenen zwei Jahrzehnten gelungen, die Krankenhaussterblichkeit bei akutem Herzinfarkt deutlich zu senken. Die prästationäre Sterblichkeit hat sich nicht in gleichem[zum vollständigen Text gelangen Sie über die oben angegebene URL]
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Non-device-based telemedical management can be useful to prevent decompensation and death in patients suffering from easily disequilibrated conditions like diabetes mellitus, chronic obstructive pulmonary disease and heart failure (HF).... more
Non-device-based telemedical management can be useful to prevent decompensation and death in patients suffering from easily disequilibrated conditions like diabetes mellitus, chronic obstructive pulmonary disease and heart failure (HF). This article summarizes current knowledge on non-device-based telemedical care for patients with HF. Several parameters (heart rate, heart rate variability, systolic blood pressure, pulse pressure, body weight, physical activity as derived from accelerometry, and occurrence of atrial and ventricular arrhythmias) have been identified as being associated with imminent clinical deterioration of HF patients. Structured telephone-based support and noninvasive telemonitoring with integrated electronic transfer of physiological data have been applied to care for HF patients and have been evaluated in multiple studies. The impact of telemedical care on clinical outcome appears to depend on the applied telemedical configuration and on the disease severity of ...
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This ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and... more
This ANSWER (EvaluAtioN of the SafeR mode in patients With a dual chambER pacemaker indication) sub-study assesses safety and effectiveness of SafeR™ and the impact of ventricular pacing (VP) prevention on anticipated device longevity and replacement rate. Patients implanted for atrioventricular block (AVB, n = 310) or sinus node dysfunction (SND, n = 336) were randomly assigned to SafeR (n = 314) or DDD (n = 318) and followed for 36 months. Safety, median VP, estimated device longevity (mean difference, 95% confidence interval [CI]), and anticipated replacement rates were analysed by pacing mode and implant indication. No difference in mortality, syncope, or mode intolerance was observed between randomization groups regardless of the indication. Ventricular pacing on SafeR vs. DDD was 11.5 vs. 93.6% in the overall population (P < 0.001), 89.2 vs. 83.8% in permanent AVB (P = 0.944), 53.5 vs. 98.2% in intermittent AVB (P < 0.001), and 2.2 vs. 84.7% in SND (P < 0.001). Antici...
Research Interests: Treatment Outcome, Medicine, Telemonitoring, Prospective studies, Humans, and 15 moreEurope, Female, Male, Cardiac Implantable Devices, Clinical Sciences, Aged, Middle Aged, Cardiac Arrhythmias, Oxford university, Cardiac Resynchronization, Cardiac pacing, Equipment Design, Heart Ventricles, Cardiac Pacemakers, and sick sinus syndrome
Research Interests: Obesity, Treatment Outcome, Heart Failure, Humans, Weight Loss, and 12 moreFemale, Male, Follow-up studies, Risk factors, Clinical Sciences, Aged, Middle Aged, Risk Factors, Cardiac-Resynchronization-Therapy-Devices-Market, Cardiac failure, cardiac resynchronization therapy, and Cardiovascular medicine and haematology
Optimization of cardiac resynchronization guided by
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darone treatment. The clinical course of amiodarone associated lung toxicity ranges from mild pneumonia to severe acute respiratory distress syndrome with fatal clinical outcome. In cases, where lung biopsies or diagnostic lung excisions... more
darone treatment. The clinical course of amiodarone associated lung toxicity ranges from mild pneumonia to severe acute respiratory distress syndrome with fatal clinical outcome. In cases, where lung biopsies or diagnostic lung excisions are taken, tissue alterations vary considerably from mild non-specific chronic interstitial pneumonia patterns, to organizing pneumonia patterns to classic diffuse alveolar damage patterns with hyaline membranes [8, 10]. Here we report the case of a patient, who developed interstitial, partially organizing pneumonia with a prominent accumulation of intraalveolar macrophages resembling a desquamative pneumonitis component during long-term low dose therapy with amiodarone.
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Das nichtärztliche Personal in Telemedizinzentren (TMZ) nimmt in der Betreuung und Behandlung von Patienten mit Herzinsuffizienz eine entscheidende Rolle ein. Aus diesem Grund ist ein ganzheitliches Anforderungsprofil bestehend aus Fach-... more
Das nichtärztliche Personal in Telemedizinzentren (TMZ) nimmt in der Betreuung und Behandlung von Patienten mit Herzinsuffizienz eine entscheidende Rolle ein. Aus diesem Grund ist ein ganzheitliches Anforderungsprofil bestehend aus Fach- und Methodenkompetenz sowie sozialer und persönlicher Kompetenz gefordert, welches in entsprechenden Schulungskonzepten aufgebaut bzw. gefördert werden sollte. Das vorliegende Positionspapier betont die Dringlichkeit einer angemessenen und standardisierten Fortbildung des nichtärztlichen Personals zur Qualitätssicherung in TMZ und fasst die Anforderungen an die Zusatzqualifikation einer Telemedizin-Assistenz übergreifend zusammen.
Zusammenfassung Ziel der Studie Die Sterblichkeit am Herzinfarkt setzt sich zusammen aus den außerhalb und innerhalb der Klinik Verstorbenen. Da es sich beim Herzinfarkt um eine schwerwiegende Erkrankung handelt, ist der Anteil an... more
Zusammenfassung Ziel der Studie Die Sterblichkeit am Herzinfarkt setzt sich zusammen aus den außerhalb und innerhalb der Klinik Verstorbenen. Da es sich beim Herzinfarkt um eine schwerwiegende Erkrankung handelt, ist der Anteil an Patienten, die vor Krankenhausaufnahme versterben, vergleichsweise groß und wie Daten aus Schweden und Augsburg zeigen in seiner relativen Häufigkeit bezogen auf alle am Infarkt Verstorbenen über die Zeit ansteigend. Ziel unserer Studie war es, für Berlin den Anteil an außerhalb zu innerhalb der Klinik am Infarkt Verstorbenen zu ermitteln. Methode Gemeinsam mit dem Berliner Zentralarchiv für Leichenschauscheine wurden alle Leichenschauscheine vom 1.7.14–30.6.15 durchgesehen und die 1076 Verstorbenen, bei denen im Leichenschauschein Infarkt nach bestimmten Suchworten oder ICD10 kodiert (I21, I22, I23) angegeben wurde, anonymisiert in unsere Studie eingeschlossen. Ergebnis Von den 1076 identifizierten Patienten verstarben 66% außerhalb und 34% während ihres ...