@article{HeidlerBiduFriedrichetal.2015,
  author    = {Heidler, Maria-Dorothea and Bidu, Laura and Friedrich, Nele and V{\"o}ller, Heinz},
  title     = {Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia},
  series = {Medizinische Klinik, Intensivmedizin und Notfallmedizin},
  volume    = {110},
  journal   = {Medizinische Klinik, Intensivmedizin und Notfallmedizin},
  number    = {1},
  publisher = {Springer},
  address   = {New York},
  issn      = {2193-6218},
  doi       = {10.1007/s00063-014-0397-5},
  pages     = {55 -- 60},
  year      = {2015},
  abstract  = {In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 \% of the patients aspirated, 71 \% of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.},
  language  = {de}
}
@article{HofmannVoellerNagelsetal.2015,
  author    = {Hofmann, Reiner and V{\"o}ller, Heinz and Nagels, Klaus and Bindl, Dominik and Vettorazzi, Eik and Dittmar, Ronny and Wohlgemuth, Walter and Neumann, Till and St{\"o}rk, Stefan and Bruder, Oliver and Wegscheider, Karl and Nagel, Eckhard and Fleck, Eckart},
  title     = {First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure - CardioBBEAT},
  series = {Trials},
  volume    = {16},
  journal   = {Trials},
  publisher = {BioMed Central},
  address   = {London},
  organization    = {CardioBBEAT Investigators},
  issn      = {1745-6215},
  doi       = {10.1186/s13063-015-0886-8},
  pages     = {12},
  year      = {2015},
  abstract  = {Background: Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Methods: Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva (R)). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months. Results: A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances. Conclusions: CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care. Overall, it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System.},
  language  = {en}
}
@article{HuberLeziusReibisetal.2015,
  author    = {Huber, Matthias and Lezius, Susanne and Reibis, Rona Katharina and Treszl, Andras and Kujawinska, Dorota and Jakob, Stefanie and Wegscheider, Karl and V{\"o}ller, Heinz and Kreutz, Reinhold},
  title     = {A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy},
  series = {International journal of molecular sciences},
  volume    = {16},
  journal   = {International journal of molecular sciences},
  number    = {8},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {1422-0067},
  doi       = {10.3390/ijms160817456},
  pages     = {17456 -- 17468},
  year      = {2015},
  abstract  = {Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 +/- 9.8 years, 83\% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) 40\% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7\%) and myocardial infarction (n = 545; 54.1\%) with a mean LVEF of 59.9\% +/- 9.3\%. The mean left ventricular mass index (LVMI) was 52.1 +/- 21.2 g/m(2.7) and 485 (48.2\%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7\% increase in LVMI (95\% CI: 1\%-12\%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.},
  language  = {en}
}
@article{MuckelbauerEnglertRieckmannetal.2015,
  author    = {Muckelbauer, Rebecca and Englert, Heike and Rieckmann, Nina and Chen, Chih-Mei and Wegscheider, Karl and V{\"o}ller, Heinz and Katus, Hugo A. and Willich, Stefan N. and M{\"u}ller-Nordhorn, Jacqueline},
  title     = {Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial},
  series = {Preventive medicine : an international journal devoted to practice and theory},
  volume    = {77},
  journal   = {Preventive medicine : an international journal devoted to practice and theory},
  publisher = {Elsevier},
  address   = {San Diego},
  issn      = {0091-7435},
  doi       = {10.1016/j.ypmed.2015.05.026},
  pages     = {155 -- 161},
  year      = {2015},
  abstract  = {Objective. We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease. Method. Secondary analysis of a randomized controlled trial: In 2002-2004,8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6 months during the 3-year follow-up. Results. In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7\% in the intervention and 21.5\% in the control group. Prevalence decreased in both groups to 16.6\% vs. 19.5\%, 153\% vs. 16.8\%, and 14.2\% vs. 15.6\% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group x time: P = 0.005). The effect was largest after 6 and 12 months [odds ratios (95\% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24 months. Conclusion. A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time. (C) 2015 Elsevier Inc. All rights reserved.},
  language  = {en}
}
@misc{PiepoliCorraAbreuetal.2015,
  author    = {Piepoli, Massimo F. and Corra, Ugo and Abreu, Ana and Cupples, Margaret and Davos, Costantinos and Doherty, Patrick and Hoefer, Stephan and Garcia-Porrero, Esteban and Rauchi, Bernhard and Vigorito, Carlo and V{\"o}ller, Heinz and Schmid, Jean-Paul},
  title     = {Challenges in secondary prevention of cardiovascular diseases A review of the current practice},
  series = {International journal of cardiology},
  volume    = {180},
  journal   = {International journal of cardiology},
  publisher = {Elsevier},
  address   = {Clare},
  organization    = {European Assoc Cardiovasc Preventi},
  issn      = {0167-5273},
  doi       = {10.1016/j.ijcard.2014.11.107},
  pages     = {114 -- 119},
  year      = {2015},
  abstract  = {With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care. (C) 2014 Elsevier Ireland Ltd. All rights reserved.},
  language  = {en}
}
@article{ReibisHuberKaroffetal.2015,
  author    = {Reibis, Rona Katharina and Huber, Matthias and Karoff, Marthin and Kamke, Wolfram and Kreutz, Reinhold and Wegscheider, Karl and V{\"o}ller, Heinz},
  title     = {Target organ damage and control of cardiovascular risk factors in hypertensive patients Evidence from the multicenter ESTher registry},
  series = {Herz : cardiovascular diseases},
  volume    = {40},
  journal   = {Herz : cardiovascular diseases},
  publisher = {Urban \& Vogel},
  address   = {M{\"u}nchen},
  issn      = {0340-9937},
  doi       = {10.1007/s00059-014-4189-8},
  pages     = {209 -- 216},
  year      = {2015},
  abstract  = {This study investigated the incidence of hypertensive target organ damage (TOD), control of cardiovascular risk factors, and the short-term prognosis in hypertensive patients under contemporary guideline-oriented therapy. A total of 1,377 consecutive patients (mean age 58.2 +/- 9.9 years, 82.2 \% male) with arterial hypertension were included in the ESTher (Endorganschaden, Therapie und Verlauf - target organ damage, therapy, and course) registry at 15 rehabilitation clinics within the framework of the National Genome Research Network. Cardiovascular risk factors, medication, comorbidities, and glomerular filtration rate (GFR) were assessed. Left ventricular hypertrophy (LVH), left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were determined by two-dimensional echocardiography. The mean follow-up was 513 +/- 159 days. Changes in continuous parameters were tested by the t test, changes in discrete characteristics are presented by means of transition tables and tested with the McNemar test. The mean LVEF was 59.3 +/- 9.9 \%, both mean LVM (238.6 +/- 101.5 g) and LVMI (54.0 +/- 23.6 g/m(2.7)) were increased while relative wall thickness (RWT, 0.46 +/- 0.18) indicated the presence of concentric LVH. Of the patients, 10.2 \% displayed renal dysfunction (estimated GFR < 60 ml/min/1.73 m(2)). The 1.5-year overall mortality was 1.2 \%. Compared with discharge, at follow-up the proportion of patients with blood pressure (BP) values < 140/90 mmHg decreased from 68.7 \% to 55.0 \% (p < 0.001) and with low-density lipoprotein (LDL) values < 100 mg/dl from 62.6 \% to 38.1 \% (p < 0.001). At follow-up significantly more patients displayed a GFR value of < 60 ml/min/1.73 m(2) (10.2 \% vs. 16.0 \%, p < 0.001). A significant proportion of hypertensive rehabilitation participants displayed TOD including LVH and renal dysfunction. Even after stringent BP reduction, a considerable increase in nephropathy could be found after 18 months.},
  language  = {en}
}
@article{ReibisJannowitzHalleetal.2015,
  author    = {Reibis, Rona Katharina and Jannowitz, Christina and Halle, Martin and Pittrow, David and Gitt, Anselm and V{\"o}ller, Heinz},
  title     = {Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers},
  series = {Current medical research and opinion},
  volume    = {31},
  journal   = {Current medical research and opinion},
  number    = {2},
  publisher = {Taylor \& Francis Group},
  address   = {London},
  issn      = {0300-7995},
  doi       = {10.1185/03007995.2014.977854},
  pages     = {211 -- 219},
  year      = {2015},
  abstract  = {Background: We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events. Methods: Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3\%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7\%) who underwent an inpatient CR period of about 3 weeks in 2009-2010. Results: Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p<0.0001), and more often had risk factors such as diabetes mellitus (39.7\% vs. 32.0\%, p<0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4\%), and reduced in patients with low EF compared to those with normal EF (47.7\% vs. 55.5\%, p<0.0001). The rate of patients that achieved lower LDL cholesterol (5100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p<0.0001) and at discharge (119/72 vs. 124/74 mmHg, p<0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p<0.0001; at discharge 85 vs. 105 Watts, p<0.0001). Event rates during CR were low, and only 0.3\% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay. Conclusions: Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved.},
  language  = {en}
}
@article{RoehrigSalzwedelLinckEleftheriadisetal.2015,
  author    = {R{\"o}hrig, Bernd and Salzwedel, Annett and Linck-Eleftheriadis, Sigrid and V{\"o}ller, Heinz and Nosper, Manfred},
  title     = {Outcome Based Center Comparisons in Inpatient Cardiac Rehabilitation Results from the EVA-Reha (R) Cardiology Project},
  series = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation},
  volume    = {54},
  journal   = {Die Rehabilitation : Zeitschrift f{\"u}r Praxis und Forschung in der Rehabilitation},
  number    = {1},
  publisher = {Thieme},
  address   = {Stuttgart},
  issn      = {0034-3536},
  doi       = {10.1055/s-0034-1395556},
  pages     = {45 -- 52},
  year      = {2015},
  abstract  = {Background: So far, for center comparisons in inpatient cardiac rehabilitation (CR), the objective outcome quality was neglected because of challenges in quantifying the overall success of CR. In this article, a multifactorial benchmark model measuring the individual rehabilitation success is presented. Methods: In 21 rehabilitation centers, 5 123 patients were consecutively enrolled between 01/2010 and 12/2012 in the prospective multicenter registry EVA-Reha (R) Cardiology. Changes in 13 indicators in the areas cardiovascular risk factors, physical performance and subjective health during rehabilitation were evaluated according to levels of severity. Changes were only rated for patients who needed a medical intervention. Additionally, the changes had to be clinically relevant. Therefore Minimal Important Differences (MID) were predefined. Ratings were combined to a single score, the multiple outcome criterion (MEK). Results: The MEK was determined for all patients (71.7 +/- 7.4 years, 76.9 \% men) and consisted of an average of 5.6 indicators. After risk adjustment for sociodemographic and clinical baseline parameters, MEK was used for center ranking. In addition, individual results of indicators were compared with means of all study sites. Conclusion: With the method presented here, the outcome quality can be quantified and outcome-based comparisons of providers can be made.},
  language  = {de}
}
@article{SalzwedelRieckReibisetal.2015,
  author    = {Salzwedel, Annett and Rieck, Angelika and Reibis, Rona Katharina and V{\"o}ller, Heinz},
  title     = {Routine initial exercise stress testing for treatment stratification in comprehensive cardiac rehabilitation},
  series = {International journal of rehabilitation research},
  volume    = {38},
  journal   = {International journal of rehabilitation research},
  number    = {4},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0342-5282},
  doi       = {10.1097/MRR.0000000000000133},
  pages     = {344 -- 349},
  year      = {2015},
  abstract  = {There is evidence of substantial benefit of cardiac rehabilitation (CR) for patients with low exercise capacity at admission. Nevertheless, some patients are not able to perform an initial exercise stress test (EST). We aimed to describe this group using data of 1094 consecutive patients after a cardiac event (71 +/- 7 years, 78\% men) enrolled in nine centres for inpatient CR. We analysed sociodemographic and clinical variables (e.g. cardiovascular risk factors, comorbidities, complications at admission), amount of therapy (e.g. exercise training, nursing care) and the results of the initial and the final 6-min walking test (6MWT) with respect to the application of an EST. Fifteen per cent of patients did not undergo an EST (non-EST group). In multivariable analysis, the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89, P=0.01], a 6MWT (per 10 m, OR 1.07, P<0.01) and lower for patients with diabetes mellitus (OR 0.48, P<0.01), NYHA-class III/IV (OR 0.27, P<0.01), osteoarthritis (OR 0.39, P<0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The non-EST group received fewer therapy units of exercise training, but more units of nursing care and physiotherapy than the EST group. However, there were no significant differences between both groups in the increase of the 6MWT during CR (123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at the start of CR as an indicator of disease severity. Nevertheless, patients without EST benefit from CR even if exercising less. Thus, there is a justified need for individualized, comprehensive and interdisciplinary CR.},
  language  = {en}
}
@article{SalzwedelWegscheiderHerichetal.2015,
  author    = {Salzwedel, Annett and Wegscheider, Karl and Herich, Lena and Rieck, Angelika and Strandt, Gert and V{\"o}ller, Heinz},
  title     = {Impact of clinical and sociodemographic patient characteristics on the outcome of cardiac rehabilitation in older patients},
  series = {Aging clinical and experimental research},
  volume    = {27},
  journal   = {Aging clinical and experimental research},
  number    = {3},
  publisher = {Springer},
  address   = {New York},
  issn      = {1594-0667},
  doi       = {10.1007/s40520-014-0283-2},
  pages     = {315 -- 321},
  year      = {2015},
  abstract  = {Background Cardiac rehabilitation (CR) seeks to simultaneously improve several outcome parameters related to patient risk factors, exercise capacity and subjective health. A single score, the multiple outcome criterion (MOC), comprised of alterations in 13 outcome variables was used to measure the overall success of CR in an older population. As this success depends on the older patient's characteristics at the time of admission to CR, we attempted to determine the most important influences. Methods The impact of baseline characteristics on the success of CR, measured by MOC, was analysed using a mixed model for 1,220 older patients (70.9 +/- A 7.0 years, 78.3 \% men) who enrolled in 12 CR clinics. A multitude of potentially influential baseline patient characteristics was considered including sociodemographic variables, comorbidity, duration of hospital stay, exercise capacity, cardiovascular risk factors, emotional status, and laboratory and echocardiographic data. Results Overall, CR was successful, as indicated by the mean value of the MOC (0.6 +/- A 0.45; min -1.0, max 2.0; positive values denoting improvement, negative ones deterioration). Examples of association with negative MOC values included smoking (MOC -0.15, p < 0.001), female gender (MOC -0.07, p = 0.049), and a longer hospital stay (MOC -0.03, p = 0.03). An example of association with positive MOC value was depression score (MOC 0.06, p = 0.003). Further associations included maximal exercise capacity, blood pressure, heart rate and the rehabilitation centre attended. Conclusion Our results emphasize the necessity to take into consideration baseline characteristics when evaluating the success of CR and setting treatment targets for older patients.},
  language  = {en}
}