Potential drug-drug interactions in patients with indication for prophylactic implantation of a cardioverter defibrillator: a cross-sectional analysis

Background: Due to demographic transition, multimorbidity and high numbers of medicinal products, polypharmacy rates will presumably further increase. This could lead to higher risks of potentially inappropriate medications with potential drug-drug interactions (PDDI). PDDI has already been investigated by several studies, but not for patients with indication for prophylactic implantation of a cardioverter defibrillator (ICD). Thus, the objective of this analysis was to examine the frequency of PDDI in that specific group of patients and compare patients with or without PDDI regarding potential underlying factors. Methods: Cross-sectional data analyses were performed using data of the prospective EU-CERT-ICD study that primarily aimed to assess ICD effectiveness in Europe. Self-reported baseline medication data of patients from Germany and Switzerland were used. Patients who reported to take at least two drugs simultaneously for at least 80 days were defined as population at risk. By means of a publicly available interaction checker, we analyzed the medication data regarding occurrence and characteristics of PDDI categorized as minor, moderate, and major PDDI. The analyses were done using descriptive methods and chi square testing. Results: The total population (n = 524) and the population at risk (n = 383) were rather similar with an average age of 64 years and about 80% male. PDDIs were found for 296 patients (in 57% of total population vs. 77% of population at risk). The moderate PDDI category was most frequently with 268 affected patients. Comparing patients with and without any PDDI, the proportion of patients with place of residence in Germany varied distinctly (93% vs. 78%). The frequency of any PDDI for the total population was twice as high in Germany as in Switzerland (p value < 0.001). Conclusions: PDDIs were frequently observed in this selected patient population and differed markedly between German and Swiss patients. The results should lead to higher awareness of polypharmacy and PDDIs. Adequate cooperation between health care providers should be promoted and new technologies such as drug interaction information systems or digital patient files used. Trial registration: The EU-CERT-ICD study is registered at www.clinicaltrials.gov (NCT02064192)

Prevalence, Mortality, and Indicators of Health Care Supply—Association Analysis of Cardiovascular Diseases in Germany

Introduction: There are regional differences in the morbidity of major cardiovascular disease between the 16 federal states of Germany. An association between the morbidity and the health care supply has been described in international studies. The aim of the present analysis was to examine the relationship between the prevalence or mortality of major cardiovascular disease and several key indicators of health care supply in Germany.Methods: Life expectancy and the proportion of over 65-year old persons were included as characteristics to depict the general health. Indicators of health care supply were the number of general practitioners, internists, and cardiologists, number of internal medicine and cardiology beds, chest pain units (CPU), cardiac catheterization laboratories (CCL) and stroke units. In the form of an ecological analysis, we compared the cardiovascular disease prevalence and mortality with these indicators and performed a weighted linear regression.Results: Regional variations between the federal states were found in general health and health care supply. The regression analysis yielded significant associations of the prevalence of major cardiovascular disease with the number of internal medicine hospital beds (β = 10.042, p = 0.045), cardiologists (β = −0.689, p = 0.031), and the number of residents per chest pain unit (β = 42,730, p = 0.036). Additionally, the relationship between cardiovascular mortality and also the number of residents per chest pain unit appeared to be significant (β = 4,962, p = 0.002). For all other indicators, no significant association was observed.Conclusions: We detected regional differences in the general health and health care supply between the 16 German federal states as well as several significant associations between cardiovascular morbidity and health care supply indicators. Especially the decreasing number of cardiologists and rising number of residents per chest pain unit with an increasing prevalence of major cardiovascular disease should lead to a discussion about the structure of the Germany health care system, such as the needs-based planning mechanism of physicians. The results of this study may also aid in future development of other health care systems

To what extent are psychiatrists aware of the comorbid somatic illnesses of their patients with serious mental illnesses? – a cross-sectional secondary data analysis

Background Somatic comorbidities are a serious problem in patients with severe mental illnesses. These comorbidities often remain undiagnosed for a long time. In Germany, physicians are not allowed to access patients’ health insurance data and do not have routine access to documentation from other providers of health care. Against this background, the objective of this article was to investigate psychiatrists’ knowledge of relevant somatic comorbidities in their patients with severe mental illnesses. Methods Cross- sectional secondary data analysis was performed using primary data from a prospective study evaluating a model of integrated care of patients with serious mental illnesses. The primary data were linked with claims data from health insurers. Patients’ diagnoses were derived on the basis of the ICD-10 and the Anatomical Therapeutic Chemical (ATC) classification system. Diabetes, hypertension, coronary artery disease (CAD), hyperlipidaemia, glaucoma, osteoporosis, polyarthritis and chronic obstructive pulmonary disease (COPD) were selected for evaluation. We compared the number of diagnoses reported in the psychiatrists’ clinical report forms with those in the health insurance data. Results The study evaluated records from 1,195 patients with severe mental illnesses. The frequency of documentation of hypertension ranged from 21% in claims data to 4% in psychiatrists’ documentation, for COPD from 12 to 0%, respectively, and for diabetes from 7 to 2%, respectively. The percentage of diagnoses deduced from claims data but not documented by psychiatrists ranged from 68% for diabetes and 83% for hypertension, to 90% for CAD to 98% for COPD. Conclusions The majority of psychiatrists participating in the integrated care programme were insufficiently aware of the somatic comorbidities of their patients. We support allowing physicians to access patients’ entire medical records to increase their knowledge of patients’ medical histories and, consequently, to increase the safety and quality of care

Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin

Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011-2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7%) completed the questionnaire. This was 50.1% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9%) and highest for home visits (18.4%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues

Epidemiology and health economic aspects of cardiovascular diseases

Hintergrund/Zielstellung: Seit Jahren ist die Bedeutung kardiovaskulärer Erkrankungen für die Bevölkerungsgesundheit unverändert hoch. Das Wissen um regionale Unterschiede im Vorkommen dieser Erkrankungen, assoziierter Risikofaktoren und bestehender Versorgungsstrukturen ist für die Konzeption passender Präventionsmaßnahmen und Versorgungsangebote entscheidend. Die Ziele der in dieser Dissertation zusammengefassten Publikationen bestanden daher in der Untersuchung regionaler Unterschiede der Prävalenz kardiovaskulärer Erkrankungen, der Bestimmung regionaler und geschlechtsspezifischer Differenzen der Prävalenz kardiovaskulärer Risikofaktoren und der Analyse von Assoziationen zwischen Prävalenz oder Mortalität kardiovaskulärer Erkrankungen und ausgewählten Indikatoren der Versorgungsstruktur. Methodik: Unter Nutzung gepoolter Daten der telefonischen Gesundheitsbefragung „Gesundheit in Deutschland aktuell“ 2009, 2010 und 2012 wurde die Lebenszeitprävalenz einer bedeutsamen kardiovaskulären Erkrankung (Herzinfarkt, Schlaganfall, Herzinsuffizienz oder andere koronare Herzerkrankung) auf Ebene der Bundesländer geschätzt und den Mortalitätsraten der entsprechenden Erkrankungen gegenübergestellt. Mit demselben Datensatz erfolgte die geschlechtsspezifische Berechnung der Prävalenz verhaltensbezogener (Rauchen, Alkoholkonsum, sportliche Inaktivität, geringer Obst-/ Gemüseverzehr) und krankheitsnaher (Diabetes, Fettstoffwechselstörung, Hypertonie, Adipositas) Risikofaktoren in den Bundesländern. Überdies wurden gewichtete lineare Regressionsanalysen zwischen der Lebenszeitprävalenz oder Mortalität einer kardiovaskulären Erkrankung und Indikatoren der Gesundheitsversorgung durchgeführt. Ergebnisse: Die niedrigste Lebenszeitprävalenz einer kardiovaskulären Erkrankung wurde in Baden-Württemberg (10,0%) und die höchste in Sachsen-Anhalt (15,8%) gefunden. Der Vergleich von Lebenszeitprävalenz und Mortalität zeigte bei vier von fünf neuen Bundesländern jeweils überdurchschnittlich hohe Werte. Ebenso wiesen die neuen Bundesländer bei vier der acht untersuchten Risikofaktoren (Hypertonie, Diabetes, Adipositas, sportliche Inaktivität) für beide Geschlechter die höchsten Prävalenzen auf. Die Unterschiede in der Lebenszeitprävalenz kardiovaskulärer Erkrankungen und assoziierter Risikofaktoren blieben auch nach statistischer Adjustierung bestehen. Die Regressionsanalysen zeigten signifikante Assoziationen der Lebenszeitprävalenz mit der Bettenzahl auf internistischen Krankenhausstationen (β = 10.042, p = 0,045), der Kardiolog*innenzahl (β = -0,689, p = 0,031) und den Einwohner*innen je Chest Pain Unit (CPU) (β = 42.730, p = 0,036). Bei der Mortalität zeigte sich mit den Einwohner*innen je CPU ein signifikanter Zusammenhang (β = 4.962, p = 0,002). Diskussion: Es bestehen in der Lebenszeitprävalenz kardiovaskulärer Erkrankungen und assoziierter Risikofaktoren erhebliche Unterschiede zwischen den Bundesländern. Für die neuen Länder sind dabei größtenteils eine höhere Werte zu beobachten, die nur teilweise durch Faktoren wie Alter und Sozialstatus erklärt werden kann. Diese Unterschiede liefern zusammen mit den gefundenen Assoziationen Anhaltspunkte, in welchen Regionen möglicherweise erhöhter Bedarf für Präventionsprogramme und Anpassungen der Versorgungsstruktur herrschen könnte.Background/Aim: The importance of cardiovascular diseases for public health has remained high for years. Knowledge of regional differences in the occurrence of these diseases, associated risk factors and existing care structures is crucial for the design of appropriate prevention programs and care services. The objectives of the publications summarized in this thesis were therefore to investigate regional differences in the prevalence of cardiovascular diseases, to determine regional and sex-specific differences in the prevalence of cardiovascular risk factors, and to analyze associations between prevalence or mortality of cardiovascular diseases and selected health care indicators. Methods: Using pooled data from the “German Health Update” of 2009, 2010 and 2012, the lifetime prevalence of major cardiovascular disease (myocardial infarction, stroke, congestive heart failure, other coronary heart disease) was estimated at the level of the German federal states and compared with mortality rates of the corresponding diseases. The sex-specific calculation of the prevalence of behavioral (smoking, alcohol consumption, sporting inactivity, low fruit/ vegetable consumption) and disease-related risk factors (diabetes, dyslipidemia, hypertension, obesity) in the federal states was carried out with the same data set. Additionally, weighted linear regression analyses between the prevalence or mortality of cardiovascular diseases and health care indicators were performed. Results: The lowest prevalence of cardiovascular disease was found in Baden-Wuerttemberg (10.0%) and the highest in Saxony-Anhalt (15.8%). The comparison of prevalence and mortality revealed above-average values in four out of five new federal states. Likewise, the new federal states showed the highest prevalence in four of the eight risk factors examined (hypertension, diabetes, obesity, physical inactivity). The differences in the prevalence of cardiovascular diseases and associated risk factors persisted after statistical adjustment. The regression analyses showed significant associations of the prevalence of cardiovascular diseases with the number of internal medicine hospital beds (β = 10,042, p = 0.045), cardiologists (β = -0.689, p = 0.031) and inhabitants per chest pain unit (CPU) (β = 42,730, p = 0.036). Regarding mortality, there was one significant correlation with the residents per CPU (β = 4,962, p = 0.002). Discussion: The prevalence of cardiovascular diseases and associated risk factors varies considerably between the federal states. For the new federal states, higher values were observed for the most part, which can only be partly explained by factors such as age and social status. Together with the revealed associations, these differences provide clues which regions might have an increased need for prevention programs and adjustments to the care structure

Use of Complementary Medicine in Competitive Sports: Results of a Cross-Sectional Study

BACKGROUND Although complementary medicine is frequently used in Germany, there is almost no information about complementary medicine use in competitive sports. The aim was to assess the use of complementary medicine among elite athletes in Germany. PATIENTS AND METHODS A cross-sectional study among athletes was performed between March 2012 and September 2013. Athletes of both sexes who visited a sports medical outpatient clinic in Munich, Bavaria were included. Data about the use of complementary medicine were collected by means of a standardized measurement instrument, the German version of the international complementary and alternative medicine questionnaire. RESULTS Of the 334 athletes (female 25%, mean age 20.2 ± 6.6 years) who completed all 4 sections of the questionnaire, 69% reported the use of at least one type of complementary medicine within the last 12 months. 505 athletes (female 26%, mean age 20.5 ± 7.0 years) completed at least one section of the questionnaire entirely. Within 12 months, the osteopath (11%), herbal medicine (17%), vitamins/minerals (32%), and relaxation techniques (15%) were the most frequently visited/used in relation to the respective sections of the questionnaire. CONCLUSION Complementary medicine is frequently used by athletes in Germany. The efficacy, safety, and costs of complementary medicine should be investigated in clinical trials among athletes in the future

Regionale Unterschiede in der Prävalenz kardiovaskulärer Erkrankungen

Hintergrund: Kardiovaskuläre Erkrankungen stehen unverändert an der Spitze der Todesursachenstatistik und verursachen den größten Anteil aller Behandlungskosten in Deutschland. Die Kenntnis regionaler Unterschiede in der Häufigkeit kardiovaskulärer Erkrankungen ist für die Planung zielgerichteter Versorgungsstrukturen und Präventionsmaßnahmen wichtig. Methode: Anhand gepoolter Daten des bundesweiten telefonischen Gesundheitssurveys Gesundheit in Deutschland aktuell (GEDA) 2009, 2010 und 2012 (n = 62 214) wurde die Lebenszeitprävalenz einer bedeutsamen kardiovaskulären Erkrankung (selbst berichtete ärztliche Diagnose von Herzinfarkt, anderer koronarer Herzkrankheit, Schlaganfall oder Herzinsuffizienz) auf Ebene der Bundesländer geschätzt. Der Einfluss soziodemografischer Merkmale auf bundeslandbezogene Prävalenzunterschiede wurde in adjustierten logistischen Regressionsanalysen untersucht. Die Prävalenzen wurden den Mortalitätsraten durch kardiovaskuläre Erkrankungen aus der Todesursachenstatistik gegenübergestellt. Ergebnisse: Die Lebenszeitprävalenz kardiovaskulärer Erkrankungen in Deutschland variierte zwischen 10,0 % in Baden-Württemberg und 15,8 % in Sachsen-Anhalt. Nach Adjustierung für Alter, Geschlecht, Sozialstatus und Gemeindegröße wiesen neun der 15 übrigen Bundesländer mit Odds Ratios zwischen 1,26 (Hessen) und 1,55 (Sachsen-Anhalt) weiterhin signifikant höhere Prävalenzen als Baden-Württemberg auf. Überdurchschnittlich hohe Werte von Prävalenz und Mortalität lagen in vier der fünf neuen Bundesländer vor. Schlussfolgerung: Es existieren relevante Bundeslandunterschiede in der Lebenszeitprävalenz bedeutsamer kardiovaskulärer Erkrankungen in Deutschland. Diese können nur teilweise durch Variationen in Alter, Geschlecht, Sozialstatus und Gemeindegröße erklärt werden

Allergic diseases in German competitive athletes : results of a cross-sectional study

BACKGROUND: Allergic diseases are common in the general population. Among the population of competitive athletes (hereafter referred to as athletes), previous studies have mostly focused on the prevalence of allergic diseases and further aspects of bronchial asthma. We aimed to examine the prevalence of allergic diseases and respective medication use in athletes in Germany. METHODS: We performed a cross-sectional study in athletes from different sport disciplines between March 2012 and September 2013 in Munich, Bavaria. Allergic diseases and medication use were descriptively determined using the standardized Allergy Questionnaire for Athletes (AQUA). Allergic predisposition was defined at an AQUA score (range 0 to 35) of at least 5. RESULTS: In total, 560 athletes (mean age 20.4 ± 6.7 years, males 73.4%, most frequent sport discipline soccer) were included in the analysis. The reported proportion of any allergic condition was 28%, and 46% of the athletes had an allergic predisposition. Sixteen percent of all athletes and 36% of athletes with an allergic predisposition reported the use of antiallergic or antiasthmatic medications. CONCLUSIONS: Athletes had a high rate of allergic diseases, and almost half of them reported an allergic predisposition. Further research is needed to validate our results and investigate the impact of allergic diseases in athletes on the performance and specific aspects of their sport, such as training intensity and duration

Physical activity trajectories among persons of Turkish descent living in Germany — a cohort study

Physical activity (PA) behavior is increasingly described as trajectories taking changes over a longer period into account. Little is known, however, about predictors of those trajectories among migrant populations. Therefore, the aim of the present cohort study was to describe changes of PA over six years and to explore migration-related and other predictors for different PA trajectories in adults of Turkish descent living in Berlin. At baseline (2011/2012) and after six years, sociodemographics, health behavior, and medical information were assessed. Four PA trajectories were defined using data of weekly PA from baseline and follow-up: “inactive”, “decreasing”, “increasing”, and “stable active”. Multivariable regression analyses were performed in order to determine predictors for the “stable active” trajectory, and results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). In this analysis, 197 people (60.9% women, mean age ± standard deviation 49.9 ± 12.8 years) were included. A total of 77.7% were first-generation migrants, and 50.5% had Turkish citizenship. The four PA trajectories differed regarding citizenship, preferred questionnaire language, and marital status. “Stable active” trajectory membership was predicted by educational level (high vs. low: aOR 4.20, 95%CI [1.10; 16.00]), citizenship (German or dual vs. Turkish only: 3.60 [1.20; 10.86]), preferred questionnaire language (German vs. Turkish: 3.35 [1.05; 10.66]), and BMI (overweight vs. normal weight: 0.28 [0.08; 0.99]). In our study, migration-related factors only partially predicted trajectory membership, however, persons with citizenship of their country of origin and/or with poor language skills should be particularly considered when planning PA prevention programs