TY  - JOUR
AB  - The German Centre for Cardiovascular Research (DZHK) is one of the German Centres for Health Research and aims to conduct early and guideline-relevant studies to develop new therapies and diagnostics that impact the lives of people with cardiovascular disease. Therefore, DZHK members designed a collaboratively organised and integrated research platform connecting all sites and partners. The overarching objectives of the research platform are the standardisation of prospective data and biological sample collections among all studies and the development of a sustainable centrally standardised storage in compliance with general legal regulations and the FAIR principles. The main elements of the DZHK infrastructure are web-based and central units for data management, LIMS, IDMS, and transfer office, embedded in a framework consisting of the DZHK Use and Access Policy, and the Ethics and Data Protection Concept. This framework is characterised by a modular design allowing a high standardisation across all studies. For studies that require even tighter criteria additional quality levels are defined. In addition, the Public Open Data strategy is an important focus of DZHK. The DZHK operates as one legal entity holding all rights of data and biological sample usage, according to the DZHK Use and Access Policy. All DZHK studies collect a basic set of data and biosamples, accompanied by specific clinical and imaging data and biobanking. The DZHK infrastructure was constructed by scientists with the focus on the needs of scientists conducting clinical studies. Through this, the DZHK enables the interdisciplinary and multiple use of data and biological samples by scientists inside and outside the DZHK. So far, 27 DZHK studies recruited well over 11,200 participants suffering from major cardiovascular disorders such as myocardial infarction or heart failure. Currently, data and samples of five DZHK studies of the DZHK Heart Bank can be applied for.
AU  - Hoffmann, J.*
AU  - Hans, S.*
AU  - Kraus, M.
AU  - Schaller, J.*
AU  - Schäfer, C.*
AU  - Stahl, D.*
AU  - Anker, S.D.*
AU  - Anton, G.
AU  - Bahls, T.*
AU  - Blankenberg, S.*
AU  - Blumentritt, A.*
AU  - Boldt, L.H.*
AU  - Cordes, S.*
AU  - Desch, S.*
AU  - Doehner, W.*
AU  - Dörr, M.*
AU  - Edelmann, F.*
AU  - Eitel, I.*
AU  - Endres, M.*
AU  - Engelhardt, S.*
AU  - Erdmann, J.*
AU  - Eulenburg, K.*
AU  - Falk, V.*
AU  - Felix, S.B.*
AU  - Frank, D.*
AU  - Franke, T.*
AU  - Frey, N.*
AU  - Friede, T.*
AU  - Geidel, L.*
AU  - Germans, L.*
AU  - Grabmaier, U.*
AU  - Halle, M.*
AU  - Hausleiter, J.*
AU  - Jakobi, V.*
AU  - Jebran, A.F.*
AU  - Jobs, A.*
AU  - Kääb, S.*
AU  - Karakas, M.*
AU  - Katus, H.A.*
AU  - Klatt, A.*
AU  - Knosalla, C.*
AU  - Krebser, J.*
AU  - Landmesser, U.*
AU  - Lee, M.*
AU  - Lehnert, K.*
AU  - Lesser, S.*
AU  - Leyh, K.*
AU  - Lorbeer, R.*
AU  - Mach-Kolb, S.
AU  - Meder, B.*
AU  - Nagel, E.*
AU  - Nolte, C.H.*
AU  - Parwani, A.S.*
AU  - Petersmann, A.*
AU  - Puls, M.*
AU  - Rau, H.*
AU  - Reiser, M.*
AU  - Rienhoff, O.*
AU  - Scharfe, T.*
AU  - Schattschneider, M.*
AU  - Scheel, H.*
AU  - Schnabel, R.B.*
AU  - Schuster, A.*
AU  - Schmitt, B.*
AU  - Seidler, T.*
AU  - Seiffert, M.*
AU  - Stähli, B.E.*
AU  - Stas, A.*
AU  - J Stocker, T.*
AU  - von Stülpnagel, L.*
AU  - Thiele, H.*
AU  - Wachter, R.*
AU  - Wakili, R.*
AU  - Weis, T.*
AU  - Weitmann, K.*
AU  - Wichmann, H.-E.
AU  - Wild, P.*
AU  - Zeller, T.*
AU  - Hoffmann, W.*
AU  - Zeisberg, E.M.*
AU  - Zimmermann, W.H.*
AU  - Krefting, D.*
AU  - Kühne, T.*
AU  - Peters, A.
AU  - Hasenfuß, G.*
AU  - Massberg, S.*
AU  - Sommer, T.*
AU  - Dimmeler, S.*
AU  - Eschenhagen, T.*
AU  - Nauck, M.*
C1  - 67750
C2  - 54060
CY  - Tiergartenstrasse 17, D-69121 Heidelberg, Germany
SP  - 923-941
TI  - The DZHK research platform: Maximisation of scientific value by enabling access to health data and biological samples collected in cardiovascular clinical studies.
JO  - Clin. Res. Cardiol.
VL  - 112
IS  - 7
PB  - Springer Heidelberg
PY  - 2023
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the treatment of hypercholesterolemia. Small interfering RNA (siRNA) inclisiran is a new drug, which targets PCSK9 mRNA in the liver, reducing concentrations of circulating LDL-C. In randomized trials, inclisiran demonstrated a substantial reduction in LDL-C. The German Inclisiran Network (GIN) aims to evaluate LDL-C reductions in a real-world cohort of patients treated with inclisiran in Germany. METHODS: Patients who received inclisiran in 14 lipid clinics in Germany for elevated LDL-C levels between February 2021 and July 2022 were included in this analysis. We described baseline characteristics, individual LDL-C changes (%) and side effects in 153 patients 3 months (n = 153) and 9 months (n = 79) after inclisiran administration. RESULTS: Since all patients were referred to specialized lipid clinics, only one-third were on statin therapy due to statin intolerance. The median LDL-C reduction was 35.5% at 3 months and 26.5% at 9 months. In patients previously treated with PCSK9 antibody (PCSK9-mAb), LDL-C reductions were less effective than in PCSK9-mAb-naïve patients (23.6% vs. 41.1% at 3 months). Concomitant statin treatment was associated with more effective LDL-C lowering. There was a high interindividual variability in LDL-C changes from baseline. Altogether, inclisiran was well-tolerated, and side effects were rare (5.9%). CONCLUSION: In this real-world patient population referred to German lipid clinics for elevated LDL-C levels, inclisiran demonstrated a high interindividual variability in LDL-C reductions. Further research is warranted to elucidate reasons for the interindividual variability in drug efficacy.
AU  - Makhmudova, U.*
AU  - Schatz, U.*
AU  - Perakakis, N.
AU  - Kassner, U.*
AU  - Schumann, F.*
AU  - Axthelm, C.*
AU  - Stürzebecher, P.*
AU  - Sinning, D.L.*
AU  - Doevelaar, A.*
AU  - Rohn, B.*
AU  - Westhoff, T.*
AU  - Vogt, A.*
AU  - Scholl, M.*
AU  - Kästner, U.*
AU  - Geiling, J.A.*
AU  - Stach, K.*
AU  - Mensch, J.*
AU  - Lorenz, E.*
AU  - Paitazoglou, C.*
AU  - Eitel, I.*
AU  - Baessler, A.*
AU  - Steinhagen-Thiessen, E.*
AU  - Koenig, W.*
AU  - Schulze, P.C.*
AU  - Landmesser, U.*
AU  - Laufs, U.*
AU  - Weingärtner, O.*
C1  - 68135
C2  - 54613
CY  - Tiergartenstrasse 17, D-69121 Heidelberg, Germany
SP  - 1639-1649
TI  - High interindividual variability in LDL-cholesterol reductions after inclisiran administration in a real-world multicenter setting in Germany.
JO  - Clin. Res. Cardiol.
VL  - 112
IS  - 11
PB  - Springer Heidelberg
PY  - 2023
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - AIMS: Observational evidence suggests that physical activity (PA) is inversely and sedentarism positively related with cardiovascular disease risk. We performed a two-sample Mendelian randomization (MR) analysis to examine whether genetically predicted PA and sedentary behavior are related to coronary artery disease, myocardial infarction, and ischemic stroke. METHODS AND RESULTS: We used single nucleotide polymorphisms (SNPs) associated with self-reported moderate to vigorous PA (n = 17), accelerometer based PA (n = 7) and accelerometer fraction of accelerations > 425 milli-gravities (n = 7) as well as sedentary behavior (n = 6) in the UK Biobank as instrumental variables in a two sample MR approach to assess whether these exposures are related to coronary artery disease and myocardial infarction in the CARDIoGRAMplusC4D genome-wide association study (GWAS) or ischemic stroke in the MEGASTROKE GWAS. The study population included 42,096 cases of coronary artery disease (99,121 controls), 27,509 cases of myocardial infarction (99,121 controls), and 34,217 cases of ischemic stroke (404,630 controls). We found no associations between genetically predicted self-reported moderate to vigorous PA, accelerometer-based PA or accelerometer fraction of accelerations > 425 milli-gravities as well as sedentary behavior with coronary artery disease, myocardial infarction, and ischemic stroke. CONCLUSIONS: These results do not support a causal relationship between PA and sedentary behavior with risk of coronary artery disease, myocardial infarction, and ischemic stroke. Hence, previous observational studies may have been biased.
AU  - Bahls, M.*
AU  - Leitzmann, M.F.*
AU  - Karch, A.*
AU  - Teumer, A.*
AU  - Dörr, M.*
AU  - Felix, S.B.*
AU  - Meisinger, C.
AU  - Baumeister, S.
AU  - Baurecht, H.*
C1  - 61675
C2  - 50384
CY  - Tiergartenstrasse 17, D-69121 Heidelberg, Germany
SP  - 1564-1573
TI  - Physical activity, sedentary behavior and risk of coronary artery disease, myocardial infarction and ischemic stroke: A two-sample Mendelian randomization study.
JO  - Clin. Res. Cardiol.
VL  - 110
IS  - 10
PB  - Springer Heidelberg
PY  - 2021
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - Background: In chronic obstructive pulmonary disease (COPD), gender-specific differences in the prevalence of symptoms and comorbidity are known. Research question: We studied whether the relationship between these characteristics depended on gender and carried diagnostic information regarding cardiac comorbidities. Study design and methods: The analysis was based on 2046 patients (GOLD grades 1–4, 795 women; 38.8%) from the COSYCONET COPD cohort. Assessments comprised the determination of clinical history, comorbidities, lung function, COPD Assessment Test (CAT) and modified Medical Research Council dyspnea scale (mMRC). Using multivariate regression analyses, gender-specific differences in the relationship between symptoms, single CAT items, comorbidities and functional alterations were determined. To reveal the relationship to cardiac disease (myocardial infarction, or heart failure, or coronary artery disease) logistic regression analysis was performed separately in men and women. Results: Most functional parameters and comorbidities, as well as CAT items 1 (cough), 2 (phlegm) and 5 (activities), differed significantly (p < 0.05) between men and women. Beyond this, the relationship between functional parameters and comorbidities versus symptoms showed gender-specific differences, especially for single CAT items. In men, item 8 (energy), mMRC, smoking status, BMI, age and spirometric lung function was related to cardiac disease, while in women primarily age was predictive. Interpretation: Gender-specific differences in COPD not only comprised differences in symptoms, comorbidities and functional alterations, but also differences in their mutual relationships. This was reflected in different determinants linked to cardiac disease, thereby indicating that simple diagnostic information might be used differently in men and women. Clinical trial registration: The cohort study is registered on ClinicalTrials.gov with identifier NCT01245933 and on GermanCTR.de with identifier DRKS00000284, date of registration November 23, 2010. Further information can be obtained on the website http://www.asconet.net.
AU  - Trudzinski, F.C.*
AU  - Kellerer, C.*
AU  - Jörres, R.A.*
AU  - Alter, P.*
AU  - Lutter, J.
AU  - Trinkmann, F.*
AU  - Herth, F.J.F.*
AU  - Frankenberger, M.*
AU  - Watz, H.*
AU  - Vogelmeier, C.F.*
AU  - Kauczor, H.U.*
AU  - Welte, T.*
AU  - Behr, J.*
AU  - Bals, R.*
AU  - Kahnert, K.*
C1  - 62737
C2  - 51031
CY  - Tiergartenstrasse 17, D-69121 Heidelberg, Germany
TI  - Gender-specific differences in COPD symptoms and their impact for the diagnosis of cardiac comorbidities.
JO  - Clin. Res. Cardiol.
PB  - Springer Heidelberg
PY  - 2021
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - Background: Anxiety has been identified as a cardiac risk factor. However, less is known about the impact of generalized anxiety disorder (GAD) on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of GAD on prehospital delay and delay related cognition and behavior. Methods: Data were from the cross-sectional Munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on socio-demographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. Results: A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was associated with decreased odds of delay compared to patients without GAD (OR 0.58, 95% CI 0.35–0.96), which was more significant in women (112 vs. 238 min, p = 0.02) than in men (150 vs. 198 min, p = 0.38). GAD was highly correlated with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the effect remained significant after controlling for these two covariates. GAD patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% CI 1.37–4.76) in 6 months before MI, which leads to the higher likelihood of making self-decision to go to the hospital (OR 2.68, 95% CI 1.48–4.85) in the acute phase. However, GAD was also highly associated with impaired psychological well-being, stress and fatigue (p < 0.0001). Conclusions: In AMI patients, GAD was independently associated with less prehospital delay, but led to an impaired psychological state.
AU  - Fang, X.
AU  - Spieler, D.
AU  - Albarqouni, L.
AU  - Ronel, J.*
AU  - Ladwig, K.-H.
C1  - 52855
C2  - 44294
SP  - 471-478
TI  - Impact of generalized anxiety disorder (GAD) on prehospital delay of acute myocardial infarction patients. Findings from the multicenter MEDEA study.
JO  - Clin. Res. Cardiol.
VL  - 107
IS  - 6
PY  - 2018
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - BACKGROUND: Fear of death (FoD) is an exceptionally stressful symptom of ST-elevation myocardial infarction (STEMI), which received little scientific attention in recent years. We aimed to describe the prevalence and factors contributing to FoD among STEMI patients and assess the impact of FoD on prehospital delay. METHODS: This investigation was based on 592 STEMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. Multivariate logistic regression models were used to identify factors associated with FoD. RESULTS: A total of 15 % of STEMI patients reported FoD (n = 88), no significant gender difference was found. STEMI pain strength [OR = 2.3 (1.4-3.9)], STEMI symptom severity [OR = 3.7 (2-6.8)], risk perception pre-STEMI [OR = 1.9 (1.2-3.2)] and negative affectivity [OR = 1.9 (1.2-3.1)] were independently associated with FoD. The median delay for those who experienced FoD was 139 min compared to 218 min for those who did not (p = 0.005). Male patients with FoD were significantly more likely to delay less than 120 min [OR = 2.11(1.25-3.57); p = 0.005], whereas in women, this association was not significant. Additionally, a clear dose-response relationship between fear severity and delay was observed. Male FoD patients significantly more often used emergency services to reach the hospital (p = 0.003). CONCLUSIONS: FoD is experienced by a clinically meaningful minority of vulnerable STEMI patients and is strongly associated with shorter delay times in men but not in women. Patients' uses of emergency services play an important role in reducing the delay in male FoD patients.
AU  - Albarqouni, L.
AU  - von Eisenhart Rothe, A.
AU  - Ronel, J.*
AU  - Meinertz, T.*
AU  - Ladwig, K.-H.
C1  - 46422
C2  - 37543
CY  - Heidelberg
SP  - 135-144
TI  - Frequency and covariates of fear of death during myocardial infarction and its impact on prehospital delay: Findings from the multicentre MEDEA study.
JO  - Clin. Res. Cardiol.
VL  - 105
IS  - 2
PB  - Springer Heidelberg
PY  - 2016
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  -  Little is known about the association between muscle strength and inflammation in diseased individuals and particularly in cardiac patients. Thus, our purpose was to examine the association of muscular strength with the inflammatory status in older adults with and without cardiac disease. The cross-sectional analysis was based on 1079 adults aged 65–94 years, who participated in the KORA-Age study. Participants underwent an interview and extensive physical examinations including anthropometric measurements, registration of diseases and drug intake, determination of health-related behaviors, collection of blood samples for measurements of interleukin-6 and hs-CRP and muscle strength measurement using hand-grip dynamometry. Cardiac patients (n = 323) had higher levels of IL-6 and poorer muscle strength compared with older adults without cardiac disease. Among persons with cardiac diseases, muscle strength in the lower tertile compared to the upper tertile was significantly associated with increased odds of having elevated IL-6 levels (OR 3.53, 95 % CI 1.18–10.50, p = 0.024) after controlling for age, gender, body fat, alcohol intake, smoking status, diseases, medications and physical activity, whereas the association between muscle strength and hs-CRP remained borderline significant (OR 2.80, 95 % CI 0.85–9.24, p = 0.092). The same trends, with slightly lower odds ratios, were also observed in older adults without cardiac disease. Lower levels of muscular strength are associated with higher concentrations of IL-6 and hs-CRP in elderly individuals with and without cardiac disease suggesting a significant contribution of the muscular system in reducing low-grade inflammation that accompanies cardiac disease and aging.
AU  - Volaklis, K.A.*
AU  - Halle, M.*
AU  - Koenig, W.*
AU  - Oberhoffer, R.*
AU  - Grill, E.*
AU  - Peters, A.
AU  - Strasser, B.*
AU  - Heier, M.
AU  - Emeny, R.T.
AU  - Schulz, H.
AU  - Ladwig, K.-H.
AU  - Meisinger, C.
AU  - Thorand, B.
C1  - 44964
C2  - 37125
SP  - 982-989
TI  - Association between muscular strength and inflammatory markers among elderly persons with cardiac disease: Results from the KORA-Age study.
JO  - Clin. Res. Cardiol.
VL  - 104
IS  - 11
PY  - 2015
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - Use of the four evidence-based medications [EBMs: antiplatelet agent, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB)] after acute myocardial infarction (AMI) has a clear impact on 1-year survival. Aim of this study was to evaluate the association between different EBM combinations at discharge and long-term survival after AMI. From a German population-based AMI registry, 2,886 men and 958 women were included, aged 28-74 years, hospitalized with an incident AMI between 2000 and 2008. All data were collected by standardized interviews and chart review. All-cause mortality was assessed for all registered persons in 2010. Median follow-up time was 6.0 years (interquartile range 4.1 years). Survival analyses and multivariate Cox regression analysis were conducted. Of the 3,844 patients, 70.3 % were prescribed all four EBMs; 23.8 % received three, 4.6 % two, and 1.3 % were discharged with one or no EBM. Long-term survival was 71.7 % [95 % confidence interval (CI) 55.4-82.9 %], 64.7 % (95 % CI 59.2-69.6 %) and 60.2 % (95 % CI 51.9-67.5 %) in patients with four, three and < 3 EBMs, respectively. Patients prescribed three or less EBMs without ACEI/ARB showed similar long-term survival to those receiving four EBMs. In Cox regression analysis after adjustment for confounding variables, the hazard ratio for long-term mortality in patients with four EBMs versus three or less EBMs was 0.63 (95 % CI 0.53-0.74). Prescribing of a combination of all four EBMs appeared to improve clinical outcomes in AMI patients by significantly reducing long-term mortality. Hospital discharge is a critical time for optimal long-term management.
AU  - Amann, U.
AU  - Kirchberger, I.
AU  - Heier, M.
AU  - Golueke, H.
AU  - von Scheidt, W.*
AU  - Kuch, B.*
AU  - Peters, A.
AU  - Meisinger, C.
C1  - 31938
C2  - 34897
CY  - Heidelberg
SP  - 655-664
TI  - Long-term survival in patients with different combinations of evidence-based medications after incident acute myocardial infarction: Results from the MONICA/KORA Myocardial Infarction Registry.
JO  - Clin. Res. Cardiol.
VL  - 103
IS  - 8
PB  - Springer Heidelberg
PY  - 2014
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - BACKGROUND: Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. METHODS: The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. RESULTS: Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95 % CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95 % CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95 % CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. CONCLUSIONS: This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.  
AU  - Stark, R.G.
AU  - Kirchberger, I.
AU  - Hunger, M.
AU  - Heier, M.
AU  - Leidl, R.
AU  - von Scheidt, W.*
AU  - Meisinger, C.
AU  - Holle, R.
C1  - 28564
C2  - 33454
CY  - Heidelberg
SP  - 237-245
TI  - Improving care of post-infarct patients: Effects of disease management programmes and care according to international guidelines.
JO  - Clin. Res. Cardiol.
VL  - 103
IS  - 3
PB  - Springer
PY  - 2014
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - The patients' misinterpretation of symptoms of an evolving acute myocardial infarction (AMI) is a major cause for prolonged pre-hospital delays. The objective of this study was to identify factors associated with an attribution of the symptoms to the heart and to investigate the association between symptom misinterpretation and time until first medical contact (delay time). The study population comprised 1,684 men and 559 women, aged 25-74 years, hospitalized with a first-time AMI recruited from a population-based AMI Registry. A total of 50.3 % of the patients attributed their experienced symptoms to the heart. Logistic regression modeling revealed that symptoms like chest pain, pain in the left upper extremity, and fear of death facilitated a correct attribution to the heart, whereas symptoms like vomiting or pain in the right upper extremity made a correct labeling difficult. Female sex, low educational status, migration background, and current smoking were associated with a higher risk of misinterpretation of symptoms. A family history of AMI or a history of angina pectoris, hypertension, and hyperlipidemia were shown to facilitate a correct interpretation of symptoms. Variables associated with a misinterpretation of symptoms did not significantly differ between men and women. People with misinterpretation of symptoms had a 1.59-fold risk (95 % confidence interval 1.33-1.90) to have a delay time of at least 2 h, compared with persons who correctly attributed their symptoms. Symptom misinterpretation is common among patients with AMI, significantly related to symptoms, sociodemographic characteristics and individual risk factors, and associated with a prolonged delay time.
AU  - Kirchberger, I.
AU  - Heier, M.
AU  - Wende, R.*
AU  - von Scheidt, W.*
AU  - Meisinger, C.
C1  - 11105
C2  - 30535
SP  - 909-916
TI  - The patient's interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment: The MONICA/KORA myocardial infarction registry.
JO  - Clin. Res. Cardiol.
VL  - 101
IS  - 11
PB  - Springer
PY  - 2012
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - To investigate the association between admission C-reactive protein (CRP) levels and 28-day case fatality as well as long-term mortality after an incident acute myocardial infarction (AMI) in non-diabetic and diabetic patients. The study was based on 461 diabetic and 1,124 non-diabetic persons consecutively hospitalized with a first-ever MI between January 1998 and December 2003 recruited from a population-based MI registry. The study population was stratified into two groups of admission CRP concentrations (cut-off point median
AU  - Meisinger, C.
AU  - Heier, M.
AU  - von Scheidt, W.*
AU  - Kuch, B.*
C1  - 2741
C2  - 28186
CY  - Heidelberg
SP  - 817-823
TI  - Admission C-reactive protein and short- as well as long-term mortality in diabetic versus non-diabetic patients with incident myocardial infarction.
JO  - Clin. Res. Cardiol.
VL  - 99
IS  - 12
PB  - Springer
PY  - 2010
SN  - 1861-0684
ER  - 

TY  - JOUR
AB  - BACKGROUND: Since the late 1990 s, cost pressure has led to a growing interest in outpatient rehabilitation in Germany where predominantly inpatient rehabilitation has been provided. Taking into account the feasibility of a randomized design, the aim of this study was to compare outpatient and inpatient cardiac rehabilitation from a societal perspective. METHOD: A comprehensive cohort design was applied. Costs during rehabilitation were measured using individual documentation of the rehabilitation centers. Economic end points were quality of life (EQ-5D), and total direct and indirect costs. A propensity score approach, integrated into a simultaneous regression framework for cost and effects, was used to control for selection bias. Bootstrap analysis was applied for assessing uncertainty in cost-effectiveness. RESULTS: A total of 163 patients were included in the study (112 inpatients, 51 outpatients). As randomization was chosen by only 2.5% of participants, the study had to be analyzed as an observational study. Direct costs during inpatient rehabilitation were significantly higher by 600 euro (+/-318; p < 0.001) compared to outpatient rehabilitation (2,016 euro +/- 354 euro vs. 1,416 euro +/- 315), while there was no significant difference in health-related quality of life. Over the 12-month follow-up period, adjusted costs difference in total cost was estimated at -2,895 euro (p = 0.102) and adjusted difference in effects at 0.018 quality-adjusted life years (QALYs) (n.s.) in favor of outpatient treatment. CONCLUSION: The ratio of mean cost over mean effect difference (incremental cost-effectiveness ratio) indicates dominance of outpatient rehabilitation, but at a considerable statistical uncertainty. However, outpatient rehabilitation cannot be rejected from an economic perspective.
AU  - Schweikert, B.
AU  - Hahmann, H.*
AU  - Steinacker, J.M.*
AU  - Imhof, A.*
AU  - Muche, R.*
AU  - Koenig, W.*
AU  - Liu, Y.F.*
AU  - Leidl, R.
C1  - 4394
C2  - 28067
SP  - 787-795
TI  - Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation.
JO  - Clin. Res. Cardiol.
VL  - 98
IS  - 12
PB  - Springer
PY  - 2009
SN  - 1861-0684
ER  -