TY - JOUR A1 - Völler, Heinz A1 - Bindl, Dominik A1 - Nagels, Klaus A1 - Hofmann, Reiner A1 - Vettorazzi, Eik A1 - Wegscheider, Karl A1 - Fleck, Eckart A1 - Störk, Stefan A1 - Nagel, Eckhard T1 - The first year of noninvasive remote telemonitoring in chronic heart failure is not cost saving but improves quality of life: the randomized controlled cardiobbeat trial JF - Telemedicine and e-health N2 - Introduction: Remote telemonitoring (RTM) for patients with chronic heart failure (HF) holds promise to improve prognosis and well-being beyond the standard of care (SoC). The CardioBBEAT trial assessed the health economic and clinical impact of an interactive bidirectional RTM system (Motiva(R)) versus SoC for patients with HF and a reduced ejection fraction (HFrEF), in Germany.Methods: This multicenter, randomized controlled trial enrolled 621 patients with HFrEF (mean age 63.0 +/- 11.5 years, 88% men). The primary endpoint was the integrated effect of the intervention on total costs and nonhospitalized days alive after 12 months, reported as incremental cost-effectiveness ratio (ICER). Costs (in keuro) were based on actual charges of patients' statutory health insurance. Among secondary outcome measures were mortality and disease-specific quality of life.Results: We found a neutral effect on nonhospitalized days alive (RTM mean 341 +/- 59 days, SoC 346 +/- 45 days; p = 0.298) associated with increased total costs (RTM 18.5 +/- 39.5 keuro, SoC 12.8 +/- 22.0 keuro; p = 0.046). This yielded an ICER of -1.15 keuro/day. RTM did not impact mortality risk. All quality of life scales were consistently and meaningfully improved in the RTM group at 12 months compared to SoC (all p < 0.01).Conclusions: The first 12 months of RTM were not cost-effective compared to SoC in patients with HFrEF, but associated with a relevant improvement in disease-specific quality of life. The balanced assessment of the potential benefit of RTM requires integration of both the societal and patient perspective.ClinTrials.gov (NCT02293252). KW - telemonitoring KW - telemedicine KW - heart failure KW - health cost KW - ICER KW - quality KW - of life KW - prognosis Y1 - 2022 U6 - https://doi.org/10.1089/tmj.2022.0021 SN - 1530-5627 SN - 1556-3669 VL - 28 IS - 11 SP - 1613 EP - 1622 PB - Liebert CY - New Rochelle ER - TY - JOUR A1 - Tschorn, Mira A1 - Kuhlmann, Stella Linnea A1 - Rieckmann, Nina A1 - Beer, Katja A1 - Grosse, Laura A1 - Arolt, Volker A1 - Waltenberger, Johannes A1 - Haverkamp, Wilhelm A1 - Müller-Nordhorn, Jacqueline A1 - Hellweg, Rainer A1 - Ströhle, Andreas T1 - Brain-derived neurotrophic factor, depressive symptoms and somatic comorbidity in patients with coronary heart disease JF - Acta Neuropsychiatrica N2 - Objective: Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analysed the relationship between BDNF and depression in a sample of patients with CHD and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS) or congestive heart failure (CHF). Methods: The following variables were assessed for 225 hospitalised patients with CHD: BDNF concentrations, depression [Patient Health Questionnaire-9 (PHQ-9)], somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status and antidepressant treatment. Results: Regression models revealed that BDNF was not associated with severity of depression. Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p = 0.04), this was not statistically significant after controlling for confounders (p = 0.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p = 0.08, p = 0.06, respectively). BDNF was reduced in patients with CHF (p = 0.02). There was no covariate-adjusted, significant association between BDNF and ACS. Conclusion: Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF. KW - depression KW - BDNF KW - coronary heart disease KW - heart failure KW - somatic comorbidity KW - acute coronary syndrome Y1 - 2020 U6 - https://doi.org/10.1017/neu.2020.31 SN - 1601-5215 SN - 0924-2708 VL - 33 IS - 1 SP - 22 EP - 30 PB - Cambridge Univ. Press CY - Cambridge ER - TY - JOUR A1 - Heringer-Walther, Silvia A1 - Moreira, Maria da Consolacao V. A1 - Wessel, Niels A1 - Wang, Yong A1 - Ventura, Pago Moreira A1 - Schultheiss, Heinz-Peter A1 - Walther, Thomas T1 - Does the C-type natriuretic peptide have prognostic value in Chagas disease and other dilated cardiomyopathies JF - Journal of cardiovascular pharmacology N2 - Atrial natriuretic peptides (ANP) and brain natriuretic peptides (BNP) are powerful neurohormonal indicators of left-ventricular function and prognosis in heart failure (HF). Chagas disease (CD) caused by the protozoan Trypanosoma cruzi. remains a major cause of HF in Latin America. We assessed whether the plasma concentration of the third natriuretic peptide, C-type natnuretic peptide (CNP), also has diagnostic and prognostic properties in patients with CD or other dilated cardiomyopathies (DCM). Blood samples were obtained from 66 patients with CD, 50 patients with DCM from other causes, and 30 gender- and age-matched healthy subjects. Patients were subdivided according to the New York Heart Association (NYHA) class. The CNP concentration was determined by radioimmunoassay (Immundiagnostik, Bensheim, Germany). The main duration of follow-up was 31.4 months (range 13 to 54 months), 19 patients had died and 11 patients received a heart transplant. CNP concentrations were only significantly altered in patients with DCM or CD of the NYHA classes III and IV (P < 0.05). The Pearson correlation of echocardiographic data with CNP revealed an association only with the left-ventricular end systolic volume (P = 0.03) in patients with DCM. Furthermore, CNP did not predict mortality or the necessity for heart transplant. Our data are the first to demonstrate the raised levels of the third natriuretic peptide CNP in CD and other DCM Whereas ANP and BNP have a high predictive value for mortality in both diseases, CNP is without any predictive potency. KW - cardiomyopathy KW - heart failure KW - natriuretic peptide system KW - Trypanosoma cruzi Y1 - 2006 U6 - https://doi.org/10.1097/01.fjc.0000249892.22635.46 SN - 0160-2446 VL - 48 IS - 6 SP - 293 EP - 298 PB - Lippincott Williams & Wilkins CY - Philadelphia ER -