A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems.

In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe

Data sharing: A new editorial initiative of the international committee of medical journal editors. Implications for the editors´ network

The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiolog

Data sharing: A new editorial initiative of the international committee of medical journal editors. Implications for the editors´ network

The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiolog

Heart Failure Treatment in Integrated Care Models According to </n> 140 SGB V

Zusammenfassung Deutschlandweit werden uber 20.000 Patienten in integrierten Herzinsuffizienz-Versorgungsmodellen betreut (Bundesverband Niedergelassener Kardiologen, personliche Kommunikation, 16. Juli 2020). Durch eine damit einhergehende, leitliniengerechte Pharmakotherapie und regelma ss ige Kontrolluntersuchungen lasst sich die Lebensqualitat von herzinsuffizienten Patienten deutlich verbessern. Daruber hinaus lassen sich Krankenhauseinweisungen und daraus resultierend Kosten fur die Krankenversicherungen minimieren. Eine enge Kooperation (in einem Netzwerk) zwischen Klinikkardiologen, niedergelassenen Kardiologen und Hausarzten ermoglicht eine optimale Herzinsuffizienz-Behandlung in allen Herzinsuffizienz-Schweregraden. Integrierte Versorgungmodelle wie CorBene oder KardioExpert tragen dazu bei, neben einer optimalen Patientenbetreuung, wissenschaftliche Auswertungen vorzunehmen und harte Endpunkte wie Re-Hospitalisierung oder kardiovaskulare Mortalitat zu reduzieren. Das hier vorgestellte KHAD-Modell (Kolner Herzen Atmen durch) ist ein integriertes Versorgungsmodell in dem die aktuellen Leitlinienempfehlungen zur poststationaren Versorgung von Herzinsuffizienzpatienten in der Region Koln umgesetzt werden sollen. Fast allen Krankenkassen unterstutzen das Modell. Es nehmen alle Kolner Krankenhauser und einige der niedergelassenen Kolner Kardiologen teil, um eine optimale Herzinsuffizienz-Versorgung gewahrleisten zu konnen. Solche Modelle fur eine Herzinsuffizienz-Betreuung konnten in allen deutschen Gro ss stadten praktiziert werden. Zum Wohle der Patienten, zur Einsparung von Potenzialen bei den Krankenkassen, fur eine angemessene Honorierung der behandelnden Arzte und zur Entlastung der Krankenhauser - ein Gewinn fur unsere Patienten und alle Beteiligten im Gesundheitssystem. Abstract Across Germany, more than 20,000 patients are cared for in integrated heart failure care models (Federal Association of General Practitioners of Cardiology, personal communication, 16 July 2020). The quality of life of patients with heart failure can be significantly improved by means of pharmacotherapy in accordance with guidelines and regular check-ups. In addition, hospital admissions and the resulting costs for health insurance companies can be minimised. Close cooperation (in a network) between clinical cardiologists, cardiologists in private practice and general practitioners enables optimal heart failure treatment in all degrees of heart failure. Integrated care models such as CorBene or KardioExpert contribute to optimal patient care, scientific evaluations and the reduction of hard endpoints such as re-hospitalisation or cardiovascular mortality. The KHAD model Kolner Herzen Atmen durch presented here is an integrated care model in which the current guidline recommendations for post-inpatient care of heart failure patients in the Cologne region are implemented. The model is supported by almost all health insurance companies. All Cologne hospitals and some of the Cologne cardiologists in private practice participate in order to ensure optimal heart failure care. Such models for heart failure care could be practised in all major German cities. For the benefit of the patients, for saving potential with the health insurance companies, for an appropriate remuneration of the attending physicians and to relieve the hospitals - a benefit for our patients and all those involved in the health system

Curriculum for Training as Spezialized Assistant in Heart Failure

The European Guidelines for the Diagnosis and Treatment of Heart Failure recommend the implementation of multidisciplinary care programs to more appropriately address the growing number of patients with heart failure. Numerous important and frequently time-consuming tasks can be delegated within these care programs to specialized non-physician staff. Tasks include counselling, monitoring, communication, organization, documentation. The here described curriculum for heart failure specialized non-physician staff was designed for the outpatient German health care system and is executed under the auspices of the German Cardiac Society

Effectiveness and Tolerability of Ivabradine with or Without Concomitant Beta-Blocker Therapy in Patients with Chronic Stable Angina in Routine Clinical Practice

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s12325-016-0377-7">https://link.springer.com/article/10.1007/s12325-016-0377-7</a></p><p></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p

Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014

Since 2008, the German Cardiac Society (DGK) has been establishing a network of certified chest pain units (CPUs). The goal of CPUs was and is to carry out differential diagnostics of acute or newly occurring chest pain of undetermined origin in a rapid and goal-oriented manner and to take immediate therapeutic measures. The basis for the previous certification process was criteria that have been established and published by the task force on CPUs. These criteria regulate the spatial and technical requirements and determine diagnostic and therapeutic strategies in patients with chest pain. Furthermore, the requirements for the organization of CPUs and the training requirements for the staff of a CPU are defined. The certification process is carried out by the DGK; currently, 225 CPUs are certified and 139 CPUs have been recertified after running for a period of 3 years. The certification criteria have now been revised and updated according to new guidelines

Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia

OBJECTIVES: The beneficial effects of cardiac resynchronization therapy (CRT) are thought to result from favorable left ventricular (LV) reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA) is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders. METHODS: In this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF) ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA. RESULTS: In total 126 consecutive patients (64±11 years; 67%male) were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583) only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p<0.0001) under CRT. In total in 56 patients VA were observed during a mean follow-up of 28±14 months, with CRT responders experiencing fewer VA than non-responders (35% vs. 58%, p<0.0061). Secondary preventive CRT implantation was associated with a higher likelihood of VA. As determined by ROC analysis an increase of LVEF by >7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606). CONCLUSIONS: Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia