TY  - JOUR
A1  - Konrad, Marcel
A1  - Jacob, Louis
A1  - Rapp, Michael Armin
A1  - Kostev, Karel
T1  - Depression risk in patients with coronary heart disease in Germany
JF  - World Journal of Cardiology
N2  - AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1: 1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95% CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management.
KW  - Coronary heart disease
KW  - Depression
KW  - Primary care
KW  - Risk factors
KW  - Quality of life
Y1  - 2016
U6  - https://doi.org/10.4330/wjc.v8.i9.547
SN  - 1949-8462
VL  - 8
SP  - 547
EP  - 552
PB  - Baishideng Publishing Group
CY  - Pleasanton
ER  - 
TY  - JOUR
A1  - Sánchez, Alba
A1  - Thomas, Christine
A1  - Deeken, Friederike
A1  - Wagner, Sören
A1  - Klöppel, Stefan
A1  - Kentischer, Felix
A1  - von Arnim, Chrstine A. F.
A1  - Denkinger, Michael
A1  - Conzelmann, Lars O.
A1  - Biermann-Stallwitz, Janine
A1  - Joos, Stefanie
A1  - Sturm, Heidrun
A1  - Metz, Brigitte
A1  - Auer, Ramona
A1  - Skrobik, Yoanna
A1  - Eschweiler, Gerhard W.
A1  - Rapp, Michael Armin
T1  - Patient safety, cost-effectiveness, and quality of life
BT  - reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study)
JF  - Trials
N2  - Background

Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.

Methods

The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.

Discussion

Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.

Trial registration

German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
KW  - Cross-sectoral care
KW  - Delirium prevention
KW  - Postoperative cognitive dysfunction
KW  - Dementia
KW  - Older patients
KW  - Elective surgery
KW  - Quality of life
KW  - Cost-effectiveness
Y1  - 2019
U6  - https://doi.org/10.1186/s13063-018-3148-8
SN  - 1468-6694
SN  - 1745-6215
SN  - 1468-6708
VL  - 20
IS  - 71
PB  - BioMed Central
CY  - London
ER  -