TY - JOUR A1 - Tschorn, Mira A1 - Rieckmann, Nina A1 - Arolt, Volker A1 - Beer, Katja A1 - Haverkamp, Wilhelm A1 - Martus, Peter A1 - Waltenberger, Johannes A1 - Müller-Nordhorn, Jacqueline A1 - Ströhle, Andreas T1 - Erkennungsgüte dreier deutschsprachiger Screeninginstrumente für Depression bei hospitalisierten Patienten mit koronarer Herzerkrankung T1 - Diagnostic Accuracy of German Depression Screenings in Patients with Coronary Heart Disease JF - Psychiatrische Praxis N2 - Ziel Vergleich der Erkennungsgüte von drei Depressions-Screeninginstrumenten bei Patienten mit koronarer Herzerkrankung (KHK). Methodik 1019 KHK-Patienten erhielten den Patient Health Questionnaire (PHQ-9 und PHQ-2) und die Hospital Anxiety and Depression Scale (HADS-D) sowie ein klinisches Interview (Composite International Diagnostic Interview) als Referenzstandard. Ergebnisse Bezüglich der Erkennungsgüte waren PHQ-9 und HADS-D dem PHQ-2 überlegen. Optimale Cut-off-Werte waren 7 (PHQ-9 und HADS-D) und 2 (PHQ-2). Schlussfolgerung PHQ-9 und HADS-D haben eine vergleichbare Diskriminationsfähigkeit für depressive Störungen bei KHK-Patienten. N2 - Objective To compare the diagnostic accuracy of German depression screening instruments in patients with coronary heart disease (CHD). Methods 1019 CHD patients completed the Patient Health Questionnaire (PHQ-9 and PHQ-2) and the Hospital Anxiety and Depression Scale (HADS-D). The Composite International Diagnostic Interview served as reference standard for "any depressive disorder" and "major depression". Results The accuracy of the PHQ-9 and the HADS-D was comparable according to the area under the curve, and both were superior to the PHQ-2. The optimal cut-off according to the Youden index (maximum sum of sensitivity and specificity) was 7 for both instruments. At this optimal cut-off, the PHQ-9 had a higher sensitivity compared to the HADS-D, but a lower specificity (below 68). Results remained similar when patients who reported that they currently underwent treatment for depression were excluded. Conclusion The PHQ-9 and the HADS-D have comparable overall diagnostic accuracy in CHD patients. In line with previous screening studies with CHD patients, the optimal cut-offs were below the cut-offs that are recommended in the literature. KW - coronary artery disease KW - depression KW - diagnosis KW - screening KW - validity Y1 - 2019 U6 - https://doi.org/10.1055/s-0042-123434 SN - 0303-4259 SN - 1439-0876 VL - 46 IS - 1 SP - 41 EP - 48 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Salzwedel, Annett A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Doherty, Patrick A1 - Metzendorf, Maria-Inti A1 - Hackbusch, Matthes A1 - Völler, Heinz A1 - Schmid, Jean-Paul A1 - Davos, Constantinos H. T1 - Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine BT - update of the Cardiac Rehabilitation Outcome Study (CROS-II) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Resulte Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation. KW - cardiac rehabilitation KW - cardiac rehabilitation delivery KW - acute coronary KW - syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality Y1 - 2020 U6 - https://doi.org/10.1177/2047487320905719 SN - 2047-4873 SN - 2047-4881 VL - 27 IS - 16 SP - 1756 EP - 1774 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Meng, Karin A1 - Schikora, Martin A1 - Wegscheider, Karl A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients’ disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients’ cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed. KW - Mild cognitive impairment KW - cardiac rehabilitation KW - patient education KW - coronary artery disease KW - secondary prevention Y1 - 2020 U6 - https://doi.org/10.1177/2047487318791609 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 1 SP - 46 EP - 55 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Gaede-Illig, Cathleen A1 - Limbourg, T. A1 - Jannowitz, Christina A1 - Völler, Heinz T1 - Predictors of exercise capacity improvement in patients after an acute coronary event during inpatient rehabilitation JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Zusammenfassung Hintergrund: Patienten mit koronarer Herzkrankheit verfugen uber eine altersentsprechend reduzierte korperliche Leistungsfahigkeit. Um in Abhangigkeit bestehender Patientencharakteristika ein zielgruppenspezifisches Training wahrend kardiologischer Rehabilitation zu ermoglichen, ist die Kenntnis von Einflussgro ss en auf die Steigerung der Leistungsfahigkeit wunschenswert. Methodik: In einem bundesweiten Register (TROL) wurden 47286 Patienten (mittleres Alter: 6411,62 Jahre; 74,5% Manner) eingeschlossen. Alle Patienten absolvierten zu Beginn und zum Ende der Rehabilitation einen fahrradergometrischen Belastungstest. Als abhangige Variable fur die univariate Analyse und die multivariate logistische Regression galt die Steigerung der Belastbarkeit, die uber einen Cut-off-Wert von 15 Watt Leistungszuwachs definiert wurde. Als Einflussfaktoren gingen Komorbiditaten und eine vor dem Index-Ereignis bestehende korperliche Aktivitat von>90Min/Woche in die Analyse ein. Ergebnisse: Die Leistungssteigerung aktiver im Vergleich zu inaktiven Patienten war signifikant hoher (21,84 Watt vs. 16,35 Watt; p<0,001). Korperliche Aktivitat vor dem Ereignis (Odds Ratio - OR 1,85 [95% Konfidenzintervall - CI: 1,75-1,97]) sowie mannliches Geschlecht (OR 1,62 [95% CI: 1,51-1,74]) konnten als positive, Komorbiditaten und Alter (OR 0,82 [95% CI: 0,74-0,90]) als negative Pradiktoren identifiziert werden. Schlussfolgerung: Zukunftig sollten in kardiologischen Rehabilitationseinrichtungen zielgruppenspezifische Trainingsprogramme eingesetzt werden, die die eingeschrankte Leistungsfahigkeit alterer und durch Komorbiditat limitierter Patienten berucksichtigt. Abstract Objective Patients who suffered from an acute coronary syndrome (ACS) boast a low exercise capacity (EC). To enhance EC is a core component of cardiac rehabilitation (CR). The aim of the study was to investigate predictors of exercise capacity to optimize the rehabilitation process in untrained subgroups. Method: 47286 patients (mean age 6411.62, 74.5% male) were enclosed in the TROL registry. All patients underwent a bicycle stress test at admission and discharge. The dependent variable for the univariate analysis and multivariate logistic regression was the increase of EC during CR, with a cutoff of 15 Watts (pre/post design). Furthermore comorbidities and physical activity before the index event were analyzed. Results: Exercise capacity enhancement differs between active and inactive patients significantly (21.84 Watt vs. 16.35 Watt; p<0.001). While a male gender (OR 1.62 [95% CI: 1.51-1.74]) and physical activity before rehabilitation (OR 1.85 [95% CI: 1.75-1.97]) were positive, comorbidities and age (OR 0.82 [95% CI: 0.74-0.90]) were negative predictors. Conclusion: In cardiac rehabilitation settings special exercise training programs for elderly and comorbid patients are needed, to enhance their exercise capacity sufficiently. KW - kardiologische Rehabilitation KW - korperliche Leistungsfahigkeit KW - koronare Herzkrankheit KW - inpatient cardiac rehabilitation KW - exercise capacity KW - coronary artery disease Y1 - 2014 U6 - https://doi.org/10.1055/s-0034-1370983 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 5 SP - 341 EP - 345 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Bonaventura, Klaus A1 - Sonntag, Steffen A1 - Kleber, Franz X. T1 - Antiplatelet therapy in the era of percutaneous coronary intervention with drug-eluting balloons JF - EuroIntervention : official journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) N2 - The high rate of restenosis associated with percutaneous coronary intervention (PCI) procedures can be reduced with the implantation of metallic stents into the stenotic vessels. The knowledge that neointimal formation can result in restenosis after stent implantation led to the development of drug-eluting stents (DES) which require long lasting antiplatelet therapy to avoid thrombotic complications. In the last years, the drug-eluting balloon (DEB) technology has emerged as an alternative option for the treatment of coronary and peripheral arteries. Clinical studies demonstrated the safety and effectiveness of DEB in various clinical scenarios and support the use of paclitaxel-eluting balloons for the treatment of in-stent restenosis, of small coronary arteries and bifurcations lesions. The protocols of DEB studies suggest that the dual antiplatelet therapy with aspirin and clopidogrel of four weeks after DEB is safe and effective. KW - drug-eluting balloon KW - clopidogrel KW - drug-eluting stent KW - coronary artery disease Y1 - 2011 SN - 1774-024X VL - 7 IS - 2 SP - K106 EP - K111 PB - Universitätsverlag Potsdam CY - Toulouse ER - TY - GEN A1 - Boldt, Julia A1 - Leber, Alexander W. A1 - Bonaventura, Klaus A1 - Sohns, Christian A1 - Stula, Martin A1 - Huppertz, Alexander A1 - Haverkamp, Wilhelm A1 - Dorenkamp, Marc T1 - Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany T2 - Postprints der Universität Potsdam Humanwissenschaftliche Reihe N2 - Background: Recent studies have demonstrated a superior diagnostic accuracy of cardiovascular magnetic resonance (CMR) for the detection of coronary artery disease (CAD). We aimed to determine the comparative cost-effectiveness of CMR versus single-photon emission computed tomography (SPECT). Methods: Based on Bayes' theorem, a mathematical model was developed to compare the cost-effectiveness and utility of CMR with SPECT in patients with suspected CAD. Invasive coronary angiography served as the standard of reference. Effectiveness was defined as the accurate detection of CAD, and utility as the number of quality-adjusted life-years (QALYs) gained. Model input parameters were derived from the literature, and the cost analysis was conducted from a German health care payer's perspective. Extensive sensitivity analyses were performed. Results: Reimbursement fees represented only a minor fraction of the total costs incurred by a diagnostic strategy. Increases in the prevalence of CAD were generally associated with improved cost-effectiveness and decreased costs per utility unit (Delta QALY). By comparison, CMR was consistently more cost-effective than SPECT, and showed lower costs per QALY gained. Given a CAD prevalence of 0.50, CMR was associated with total costs of (sic)6,120 for one patient correctly diagnosed as having CAD and with (sic)2,246 per Delta QALY gained versus (sic)7,065 and (sic)2,931 for SPECT, respectively. Above a threshold value of CAD prevalence of 0.60, proceeding directly to invasive angiography was the most cost-effective approach. Conclusions: In patients with low to intermediate CAD probabilities, CMR is more cost-effective than SPECT. Moreover, lower costs per utility unit indicate a superior clinical utility of CMR. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 551 KW - cost-effectiveness KW - cardiovascular magnetic resonance KW - scintigraphy KW - coronary angiography KW - coronary artery disease Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-430107 SN - 1866-8364 IS - 551 ER -