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Frankfurt am Main, Germany

Pfeiffer D.,University of Leipzig | Von Kodolitsch Y.,Universitatsklinikum Hamburg Eppendorf | Schachinger V.,Medizinische Klinik 1 | Haude M.,Medizinische Klinik 1 | And 2 more authors.
Kardiologe | Year: 2013

Patients, physicians, hospital administrations and health insurance companies are completely in agreement that necessary diagnostic and therapeutic interventions should be carried out in an outpatient setting and, if unfeasible, inpatient hospital stay should be as short and limited as possible. Insurance companies require immediate interventions on the day of admission to hospital. On the other hand there are various arguments against immediate interventions which can result in a reduction of global risks. This article summarizes the different arguments for delayed interventions in cardiovascular medicine in concordance with the German Society of Cardiology. The arguments encompass clinical reasons, missing information on preclinical investigations, necessary additional information, organizational limitations and legal reasons. A prolongation of hospital stay is acceptable if it promotes a reduction in the global risk for the patient and limitation of costs to prevent subsequent procedure-related complications. © 2013 Springer-Verlag Berlin Heidelberg.

Illmann A.,Stadtisches Klinikum Munich GmbH | Riemer T.,University of Heidelberg | Erbel R.,University of Duisburg - Essen | Giannitsis E.,University of Heidelberg | And 10 more authors.
Clinical Research in Cardiology | Year: 2014

Objectives: The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated. Background: Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS). Methods: A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed. Results: A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month follow-up, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, p < 0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1 %, p < 0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization. Conclusions: Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted. © 2013 Springer-Verlag Berlin Heidelberg.

Aims Several studies demonstrated an inverse relationship between cardioverter-defibrillator implantation volume and complication rates, suggesting better outcomes for higher volume centres. However, the association of institutional procedural volume with patient outcomes for permanent pacemaker (PPM) implantation remains less known, especially in decentralized implantation systems. Methods and results We performed retrospective examination of data on patients undergoing PPM from the German obligatory quality assurance programme (2007-12) to evaluate the relationship of hospital PPM volume (categorized into quintiles of their mean annual volume) with risk-adjusted in-hospital surgical complications (composite of pneumothorax, haemothorax, pericardial effusion, or pocket haematoma, all requiring intervention, or device infection) and pacemaker lead dislocation. Overall 430 416 PPM implantations were documented in 1226 hospitals. Systems included dual (72.8%) and single (25.8%) chamber PPM and cardiac resynchronization therapy (CRT) devices (1.1%). Complications included surgical (0.92%), and ventricular (0.99%), and atrial (1.22%) lead dislocation. Despite an increase in relatively complex procedures (dual chamber, CRT), there was a significant decrease in the procedural and fluoroscopy times and complications from lowest to highest implantation volume quintiles (P for trend <0.0001). The greatest difference was observed between the lowest (1-50 implantations/year-reference group) and the second-lowest (51-90 implantations/year) quintile: surgical complications [odds ratio (OR) 0.69; confidence interval (CI) 0.60-0.78], atrial lead dislocations (OR 0.69; CI 0.59-0.80), and ventricular lead dislocations (OR 0.73; CI 0.63-0.84). Conclusions Hospital annual PPM volume was directly related to indication-based implantation of relatively more complex PPM and yet inversely with procedural times and rates of early surgical complications and lead dislocations. Thus, our data suggest better performance and lower complications with increasing procedural volume. © The Author 2015.

Oehl F.,Institute for Sustainability science | Tchabi A.,University of Lome | Silva G.A.D.,CCB | Sanchez-Castro I.,University of Granada | And 5 more authors.
Sydowia | Year: 2014

A new arbuscular mycorrhizal fungus was isolated from the Southern Guinea savanna in Benin, which represents a tree-rich savanna in the transition between the tropical atlantic rainforests and grass-rich savannas in sub-Saharan West Africa. The fungus was propagated in bait cultures and monosporic single species cultures, and is here described as Acaulospora spinosissima. It forms spores similar to those of Acaulospora spinosa, but in A. spinosissima the outer wall is thinner and the surface ornamentation is finer. Sequences obtained from the ITS and the partial 28S of the ribosomal gene revealed that the two species are phylogenetically not closely related. The new fungus was recovered from natural savanna at two locations and from one field site under yam cultivation in the first year after tree clearance. It was not detected in agricultural field sites cultivated for more than one year.

Breuckmann F.,Arnsberg Medical Center | Hochadel M.,University of Heidelberg | Darius H.,Angiology and Intensive Care Medicine | Giannitsis E.,University of Heidelberg | And 8 more authors.
Journal of Cardiology | Year: 2015

Background: We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence. Method: Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary intervention (PCI) within <24 and <72. h after admission. Results: Overall guideline-conforming management was performed in 38.2%. In UAP patients at risk, undertreatment caused by an insufficient consideration of risk criteria was obvious in 78%. Reciprocally, overtreatment in the absence of adequate risk markers was performed in 27%, whereas a guideline-conforming primarily conservative strategy was chosen in 73% of the low-risk patients. Together, the 3-month major adverse coronary and cerebrovascular events (MACCE) were low (3.6%). Nonetheless, guideline-conforming treatment was even associated with significantly lower MACCE rates (1.6% vs. 4.0%, p<. 0.05). Conclusion: The data suggest an inadequate adherence to ESC guidelines in nearly two thirds of the patients, particularly in those patients at high to intermediate risk with secondary risk factors, emphasizing the need for further attention to consistent risk profiling in the CPU and its certification process. © 2014 Japanese College of Cardiology.

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