@article{ZetzlSchulerRenneretal.2019, author = {Zetzl, Teresa and Schuler, Michael and Renner, Agnes and Jentschke, Elisabeth and van Oorschot, Birgitt}, title = {Yoga intervention and reminder e-mails for reducing cancer-related fatigue - a study protocol of a randomized controlled trial}, series = {BMC Psychology}, volume = {7}, journal = {BMC Psychology}, doi = {10.1186/s40359-019-0339-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202268}, pages = {64}, year = {2019}, abstract = {Background Almost 90\% of cancer patients suffer from symptoms of fatigue during treatment. Supporting treatments are increasingly used to alleviate the burden of fatigue. This study examines the short-term and long-term effects of yoga on fatigue and the effect of weekly reminder e-mails on exercise frequency and fatigue symptoms. Methods The aim of the first part of the study will evaluate the effectiveness of yoga for cancer patients with mixed diagnoses reporting fatigue. We will randomly allocate 128 patients to an intervention group (N = 64) receiving yoga and a wait-list control group (N = 64) receiving yoga 9 weeks later. The yoga therapy will be performed in weekly sessions of 60 min each for 8 weeks. The primary outcome will be self-reported fatigue symptoms. In the second part of the study, the effectiveness of reminder e-mails with regard to the exercise frequency and self-reported fatigue symptoms will be evaluated. A randomized allocated group of the participants ("email") receives weekly reminder e-mails, the other group does not. Data will be assessed using questionnaires the beginning and after yoga therapy as well as after 6  months. Discussion Support of patients suffering from fatigue is an important goal in cancer patients care. If yoga therapy will reduce fatigue, this type of therapy may be introduced into routine practice. If the reminder e-mails prove to be helpful, new offers for patients may also develop from this.}, language = {en} } @article{YurdadoganMalschKotsevaetal.2021, author = {Yurdadogan, Tino and Malsch, Carolin and Kotseva, Kornelia and Wood, David and Leyh, Rainer and Ertl, Georg and Karmann, Wolfgang and M{\"u}ller-Scholden, Lara and Morbach, Caroline and Breuning, Margret and Wagner, Martin and Gelbrich, G{\"o}tz and Bots, Michiel L. and Heuschmann, Peter U. and St{\"o}rk, Stefan}, title = {Functional versus morphological assessment of vascular age in patients with coronary heart disease}, series = {Scientific Reports}, volume = {11}, journal = {Scientific Reports}, number = {1}, doi = {10.1038/s41598-021-96998-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265810}, year = {2021}, abstract = {Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VA(PWVao) in 68\% of patients; for VA\(_{AIao}\) in 52\% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VA\(_{total-cIMT}\) accelerated vascular aging in 75\% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.}, language = {en} } @phdthesis{Yurdadogan2020, author = {Yurdadogan, Tino}, title = {Endorganschaden und Gef{\"a}ßalter bei Patienten mit koronarer Herzkrankheit}, doi = {10.25972/OPUS-21846}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218469}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2020}, abstract = {Die nicht-invasive Gef{\"a}ßdiagnostik stellt einen wichtigen Pfeiler in der Pr{\"a}vention von Herz-Kreislauferkrankungen dar. W{\"a}hrend lange Zeit die sonographische Messung der cIMT, als morphologisches Korrelat der Gef{\"a}ßalterung, als Goldstandard galt, ist in den letzten Jahren in Gestalt der Pulswellenanalyse/PWV-Messung eine Technik weiterentwickelt worden, die, als funktionelles Korrelat der Gef{\"a}ßalterung, aufgrund der leichteren Durchf{\"u}hrbarkeit und geringerer Untersucherabh{\"a}ngigkeit und Kosten vielversprechend ist. So erlaubt die Messung der Pulswelle mittels gew{\"o}hnlicher Blutdruckmanschetten, genau wie die cIMT, die Berechnung des individuellen Gef{\"a}ßalters und die Diagnostik f{\"u}r das Vorliegen eines Endorganschadens der Blutgef{\"a}ße. Um die Messergebnisse der beiden Untersuchungen miteinander zu vergleichen, wurden beide in der EUROASPIRE-IV Studie an Patienten mit koronarer Herzkrankheit durchgef{\"u}hrt. Die Auswertung der Messergebnisse der mit dem Vascular Explorer durchgef{\"u}hrten Pulswellenanalyse/PWV-Messung ergab {\"u}berraschenderweise, dass die Mehrheit der herzkranken Patienten weder eine vaskul{\"a}re Voralterung noch einen Endorganschaden der Blutgef{\"a}ße aufweisen. Im Falle der cIMT-Messung war Gegenteiliges der Fall, was trotz der medikament{\"o}sen Therapie der Patienten so zu erwarten war. Weiterhin zeigte sich lediglich eine geringe Korrelation zwischen den Messergebnissen beider Untersuchungen. Die Determinanten der einzelnen Messwerte aus cIMT und Pulswellenanalyse/PWV-Messung waren deckungsgleich mit den in der Literatur beschriebenen Faktoren, wenn auch viele der sonst signifikanten Regressoren das Signifikanzniveau in unserer Auswertung nicht unterschritten. Eine Limitation der funktionellen Gef{\"a}ßdiagnostik liegt derzeit darin, dass die Messergebnisse stark von dem verwendeten Messger{\"a}t abh{\"a}ngen. Es liegen noch zu wenig Vergleichsstudien vor, um die Messergebnisse, speziell von neueren Ger{\"a}ten wie dem Vascular Explorer, auf andere zu {\"u}bertragen. Bei der Berechnung des Gef{\"a}ßalters sollten daher optimalerweise ger{\"a}tespezifische Normwerte vorliegen, was beim Vascular Explorer nicht der Fall ist. Gleiches gilt f{\"u}r die Verwendung des PWVcf-Grenzwerts f{\"u}r die Diagnose eines Endorganschadens der Blutgef{\"a}ße. Analog hat auch die Messung der cIMT gewisse Einschr{\"a}nkungen. So w{\"a}re eine weitere Standardisierung der Messorte (A. carotis communis vs Bulbus vs A. carotis interna), zwischen denen sich die durchschnittliche cIMT erheblich unterscheidet, sowie der Messparameter (Minimal- vs Maximal- vs Mittelwert) w{\"u}nschenswert. Die universelle Anwendung eines cIMT-Grenzwerts zur Diagnose eines Endorganschadens der Blutgef{\"a}ße ist daher kritisch zu sehen. Dies zeigt sich auch darin, dass in den neuesten Leitlinien der bislang geltende Grenzwert angezweifelt und kein aktuell g{\"u}ltiger Grenzwert mehr genannt wird. Wir interpretieren unsere Ergebnisse dahingehend, dass unsere Messung der cIMT die zu erwartende pathologische Gef{\"a}ßalterung bei Patienten mit koronarer Herzkrankheit besser widerspiegelt als die Messung der Pulswelle mit dem Vascular Explorer. Welche der beiden Untersuchungen hinsichtlich der prognostischen Wertigkeit {\"u}berlegen ist, muss im Rahmen von L{\"a}ngsschnittstudien gekl{\"a}rt werden.}, subject = {Arteriosklerose}, language = {de} } @article{WinterPryssProbstetal.2020, author = {Winter, Michael and Pryss, R{\"u}diger and Probst, Thomas and Reichert, Manfred}, title = {Towards the applicability of measuring the electrodermal activity in the context of process model comprehension: feasibility study}, series = {Sensors}, volume = {20}, journal = {Sensors}, number = {16}, issn = {1424-8220}, doi = {10.3390/s20164561}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-211276}, year = {2020}, abstract = {Process model comprehension is essential in order to understand the five Ws (i.e., who, what, where, when, and why) pertaining to the processes of organizations. However, research in this context showed that a proper comprehension of process models often poses a challenge in practice. For this reason, a vast body of research exists studying the factors having an influence on process model comprehension. In order to point research towards a neuro-centric perspective in this context, the paper at hand evaluates the appropriateness of measuring the electrodermal activity (EDA) during the comprehension of process models. Therefore, a preliminary test run and a feasibility study were conducted relying on an EDA and physical activity sensor to record the EDA during process model comprehension. The insights obtained from the feasibility study demonstrated that process model comprehension leads to an increased activity in the EDA. Furthermore, EDA-related results indicated significantly that participants were confronted with a higher cognitive load during the comprehension of complex process models. In addition, the experiences and limitations we learned in measuring the EDA during the comprehension of process models are discussed in this paper. In conclusion, the feasibility study demonstrated that the measurement of the EDA could be an appropriate method to obtain new insights into process model comprehension.}, language = {en} } @article{WinterPryssProbstetal.2021, author = {Winter, Michael and Pryss, R{\"u}diger and Probst, Thomas and Reichert, Manfred}, title = {Applying Eye Movement Modeling Examples to guide novices' attention in the comprehension of process models}, series = {Brain Sciences}, volume = {11}, journal = {Brain Sciences}, number = {1}, issn = {2076-3425}, doi = {10.3390/brainsci11010072}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-222966}, year = {2021}, abstract = {Process models are crucial artifacts in many domains, and hence, their proper comprehension is of importance. Process models mediate a plethora of aspects that are needed to be comprehended correctly. Novices especially face difficulties in the comprehension of process models, since the correct comprehension of such models requires process modeling expertise and visual observation capabilities to interpret these models correctly. Research from other domains demonstrated that the visual observation capabilities of experts can be conveyed to novices. In order to evaluate the latter in the context of process model comprehension, this paper presents the results from ongoing research, in which gaze data from experts are used as Eye Movement Modeling Examples (EMMEs) to convey visual observation capabilities to novices. Compared to prior results, the application of EMMEs improves process model comprehension significantly for novices. Novices achieved in some cases similar performances in process model comprehension to experts. The study's insights highlight the positive effect of EMMEs on fostering the comprehension of process models.}, language = {en} } @article{WillekeJansonZinketal.2021, author = {Willeke, Kristina and Janson, Patrick and Zink, Katharina and Stupp, Carolin and Kittel-Schneider, Sarah and Bergh{\"o}fer, Anne and Ewert, Thomas and King, Ryan and Heuschmann, Peter U. and Zapf, Andreas and Wildner, Manfred and Keil, Thomas}, title = {Occurrence of mental illness and mental health risks among the self-employed: a systematic review}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {16}, issn = {1660-4601}, doi = {10.3390/ijerph18168617}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-245085}, year = {2021}, abstract = {We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.}, language = {en} } @article{WiedmannHeuschmannHillmannetal.2014, author = {Wiedmann, Silke and Heuschmann, Peter U. and Hillmann, Steffi and Busse, Otto and Wiethoelter, Horst and Walter, Georg M. and Seidel, Guenter and Misselwitz, Bjoern and Janssen, Alfred and Berger, Klaus and Burmeister, Christoph and Matthias, Christine and Kolominsky-Rabas, Peter and Hermanek, Peter}, title = {The Quality of Acute Stroke Care-an Analysis of Evidence-Based Indicators in 260 000 Patients}, series = {Deutsches {\"A}rzteblatt International}, volume = {111}, journal = {Deutsches {\"A}rzteblatt International}, number = {45}, issn = {1866-0452}, doi = {10.3238/arztebl.2014.0759}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114747}, pages = {759-765}, year = {2014}, abstract = {Background: Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date. Methods: The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects. Results: Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7\% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6\%). Dysphagia screening was documented in 86.2\% (range, 74.8-93.1\%). For the following indicators, the defined targets were not reached for all of Germany: antiaggregation within 48 hours, 93.4\% (range, 86.6-96.4\%); anticoagulation for atrial fibrillation, 77.6\% (range, 72.4-80.1\%); standardized dysphagia screening, 86.2\% (range, 74.8-93.1\%); oral and written information of the patients or their relatives, 86.1\% (range, 75.4-91.5\%). The rate of patients examined or treated by a speech therapist was in the target range. Conclusion: The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.}, language = {en} } @article{WiedmannHeuschmannHermanek2015, author = {Wiedmann, Silke and Heuschmann, Peter U. and Hermanek, Peter}, title = {In reply: The quality of acute stroke treatment-an analysis of evidence-based indicators in 260 000 patients}, series = {Deutsches Aerzteblatt International}, volume = {112}, journal = {Deutsches Aerzteblatt International}, doi = {10.3238/arztebl.2015.0288b}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-148666}, pages = {288}, year = {2015}, abstract = {No abstract available.}, language = {en} } @article{WetzelPryssBaumeisteretal.2021, author = {Wetzel, Britta and Pryss, R{\"u}diger and Baumeister, Harald and Edler, Johanna-Sophie and Gon{\c{c}}alves, Ana Sofia Oliveira and Cohrdes, Caroline}, title = {"How come you don't call me?" Smartphone communication app usage as an indicator of loneliness and social well-being across the adult lifespan during the COVID-19 pandemic}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {12}, issn = {1660-4601}, doi = {10.3390/ijerph18126212}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241033}, year = {2021}, abstract = {Loneliness and lack of social well-being are associated with adverse health outcomes and have increased during the COVID-19 pandemic. Smartphone communication data have been suggested to help monitor loneliness, but this requires further evidence. We investigated the informative value of smartphone communication app data for predicting subjective loneliness and social well-being in a sample of 364 participants ranging from 18 to 78 years of age (52.2\% female; mean age = 42.54, SD = 13.22) derived from the CORONA HEALTH APP study from July to December 2020 in Germany. The participants experienced relatively high levels of loneliness and low social well-being during the time period characterized by the COVID-19 pandemic. Apart from positive associations with phone call use times, smartphone communication app use was associated with social well-being and loneliness only when considering the age of participants. Younger participants with higher use times tended to report less social well-being and higher loneliness, while the opposite association was found for older adults. Thus, the informative value of smartphone communication use time was rather small and became evident only in consideration of age. The results highlight the need for further investigations and the need to address several limitations in order to draw conclusions at the population level.}, language = {en} } @article{WeissGruendahlDeckertetal.2023, author = {Weiß, Martin and Gr{\"u}ndahl, Marthe and Deckert, J{\"u}rgen and Eichner, Felizitas A. and Kohls, Mirjam and St{\"o}rk, Stefan and Heuschmann, Peter U. and Hein, Grit}, title = {Differential network interactions between psychosocial factors, mental health, and health-related quality of life in women and men}, series = {Scientific Reports}, volume = {13}, journal = {Scientific Reports}, organization = {STAAB-COVID Study Group}, doi = {10.1038/s41598-023-38525-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357858}, year = {2023}, abstract = {Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the "Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)" cohort study, a representative age- and gender-stratified sample of the general population of W{\"u}rzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis.}, language = {en} } @phdthesis{Wahl2020, author = {Wahl, Valerie Elisabeth}, title = {Empfehlungen zu Lebensstilver{\"a}nderungen und deren Umsetzung nach einem koronaren Ereignis - Ergebnisse der EUROASPIRE IV-Studie im Raum W{\"u}rzburg}, doi = {10.25972/OPUS-20020}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200203}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2020}, abstract = {Die koronare Herzkrankheit ist weltweit die h{\"a}ufigste Todesursache und belastet die Gesellschaft durch Therapien und Arbeitsausf{\"a}lle mit hohen Kosten. Die Europ{\"a}ischen Gesellschaft f{\"u}r Kardiologie empfiehlt in den Leitlinien zur Sekund{\"a}rpr{\"a}vention der koronaren Herzkrankheit verschiedene Lebensstil{\"a}nderungen. In der vorliegenden Arbeit wurde untersucht, wie h{\"a}ufig diese Empfehlungen tats{\"a}chlich gegeben werden, ob diese von den Patienten umgesetzt werden und welche Faktoren den Erhalt der Empfehlung bzw. die Umsetzung beeinflussen. Hierzu wurden 536 Probanden mit bekannter KHK aus dem Raum W{\"u}rzburg im Rahmen der multizentrischen Querschnittsstudie EUROASPIRE IV befragt und untersucht. Es konnte gezeigt werden, dass die Empfehlungen insgesamt viel zu selten gegeben werden. Als positiver Einflussfaktor f{\"u}r den Erhalt einer Empfehlung konnte die Teilnahme an einem Rehabilitationsprogramm identifiziert werden. Die Wahrscheinlichkeit, die Empfehlungen zu erhalten, sank zudem mit zunehmendem Alter bei Erstdiagnose der KHK. Diese Erkenntnisse k{\"o}nnen in Zukunft dabei helfen, die Aufkl{\"a}rung {\"u}ber die Risikofaktoren insgesamt und besonders bei {\"a}lteren Menschen zu intensivieren. Sie untermauern zudem die große Bedeutung eines Rehabilitationsprogrammes bei der Informationsvermittlung. Auch die Umsetzung der empfohlenen Lebensstilver{\"a}nderungen erfolgte nicht in zufriedenstellender H{\"a}ufigkeit. F{\"u}r die Beendigung des Rauchens konnte die Teilnahme an einem Rehabilitationsprogramm als gr{\"o}ßter Einflussfaktor ermittelt werden. Die Wahrscheinlichkeit, dass die verschiedenen Maßnahmen zu Lebensstilver{\"a}nderungen umgesetzt werden, war beim weiblichen Geschlecht deutlich h{\"o}her als beim m{\"a}nnlichen. Die Umsetzung wurde zudem dadurch beeinflusst, ob der Patient vorher die entsprechende Empfehlung erhalten hatte. Die Daten zeigen somit auch bei der Umsetzung der Maßnahmen die Bedeutung von Rehabilitationsprogrammen, besonders f{\"u}r Raucher, und verdeutlichen, dass vor allem bei M{\"a}nnern weitere Anreize geschaffen werden m{\"u}ssen, damit diese die Empfehlungen zur Lebensstil{\"a}nderung auch umsetzen. Dass viel mehr Probanden die Maßnahmen umgesetzt haben, wenn sie vorher die entsprechende Empfehlung erhalten haben, unterstreicht die außerordentliche Wichtigkeit der umfassenden Aufkl{\"a}rung des Patienten {\"u}ber die existentiellen Chancen eines Lebensstilwandels.}, subject = {Koronare Herzkrankheit}, language = {de} } @article{WagnerWannerSchichetal.2017, author = {Wagner, Martin and Wanner, Christoph and Schich, Martin and Kotseva, Kornelia and Wood, David and Hartmann, Katrin and Fette, Georg and R{\"u}cker, Viktoria and Oezkur, Mehmet and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Patient's and physician's awareness of kidney disease in coronary heart disease patients - a cross-sectional analysis of the German subset of the EUROASPIRE IV survey}, series = {BMC Nephrology}, volume = {18}, journal = {BMC Nephrology}, number = {321}, doi = {10.1186/s12882-017-0730-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158387}, year = {2017}, abstract = {Background Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician's awareness of kidney disease of patients hospitalized for CHD and also the patient's awareness of CKD in a study visit following hospital discharge. Methods All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFR\(_{CKD-EPI}\) < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician's awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician. Results Of the 536 patients, 32\% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22\%, and 72\% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35\% had impaired kidney function. Of 158 patients with kidney disease, 54 (34\%) were aware of CKD. Determinants of patient's awareness were severity of CKD (OR\(_{eGFR}\) 0.94; 95\%CI 0.92-0.96), obesity (OR 1.97; 1.07-3.64), history of heart failure (OR 1.99; 1.00-3.97), and mentioning of kidney disease in the index event's hospital discharge letter (OR 5.51; 2.35-12.9). Conclusions Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient's awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician's awareness for kidney dysfunction may improve patient's awareness of CKD.}, language = {en} } @article{WagnerAshbyKurtzetal.2015, author = {Wagner, Martin and Ashby, Damien R. and Kurtz, Caroline and Alam, Ahsan and Busbridge, Mark and Raff, Ulrike and Zimmermann, Josef and Heuschmann, Peter U. and Wanner, Christoph and Schramm, Lothar}, title = {Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease}, series = {PLoS One}, volume = {10}, journal = {PLoS One}, number = {4}, doi = {10.1371/journal.pone.0123072}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125514}, pages = {e0123072}, year = {2015}, abstract = {Background Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD). It may be explained by reduced erythropoietin (EPO) synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25—the key hormone of iron-metabolism—on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels. Methods 249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD), were enrolled (2003-2005), if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine) were analyzed by Cox proportional hazards models. Results Patients (age 67 yrs, 53\% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml) were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7\%) and forty (16.1\%) patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05). Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05). Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05). Conclusions We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors of clinical outcome and have the potential to further define "high risk" populations in CKD.}, language = {en} } @phdthesis{Wagner2019, author = {Wagner, Martin}, title = {Chronic Kidney Disease as an Important Co-morbid Condition in Coronary Heart Disease Patients}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175498}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2019}, abstract = {In patients with coronary heart disease (CHD) the control of the modifiable "traditional" cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, achieving/maintaining normal body weight and smoking cessation is of major importance to improve prognosis. Guideline recommendations for secondary CHD prevention include specific treatment targets for blood pressure, lipid levels, and markers of glucose metabolism for both younger and older patients. Chronic kidney disease (CKD) has been identified as a "non-traditional" risk factor for worse outcome in CHD patients, as it is associated with a markedly increased risk for subsequent CV events and mortality. The specific objectives of the current thesis-project are to investigate (a) the quality of care in a recent sample of German CHD patients and to investigate variation of risk factor control between younger and elder patients (≤70 versus >70 years), (b) to analyze the prevalence of CKD across Europe in stable CHD patients in the outpatient setting and during a hospital stay for CHD, (c) to investigate the level of awareness of CKD in German CHD patients and their treating physicians. Data from the European-wide EUROASPIRE IV study were used that include data on 7998 CHD patients in the ambulatory setting (study visit) and during a hospital stay for CHD (index). The German EUROASPIRE IV study center in W{\"u}rzburg recruited 536 patients in 2012-2013. Risk factor control was compared against the current recommendations of the European Society of Cardiology. CKD was described by stages of glomerular filtration rate (eGFR) and albuminuria. German patients were asked in an additional kidney specific module whether they have ever been told by a physician about renal impairment. The fact that CKD or acute kidney injury (AKI) was mentioned in prominent parts of the hospital discharge letter as well as correct ICD-coding of CKD or AKI served as a proxy for physician's awareness of CKD. The majority of German CHD patients was treated with the recommended drug therapies including e.g. β-blockers, anti-platelets and statins. However, treatment targets for blood pressure and LDL-cholesterol levels were not achieved in many patients (45\% and 53\%, respectively) and glycemic control in diabetic CHD patients with HbA1-levels <7\% was insufficient (61\%). A minority of patients reported on current smoking (10\%), but unhealthy life-styles e.g. overweight/obesity (85\%/37\%) were frequent. Patterns of care differed between younger and older CHD patients while older patients were less likely to receive the recommended medical CHD-therapy, were more likely to have uncontrolled blood pressure and also to be diabetic. However, a greater proportion of diabetic patients >70 years was achieving the HbA1c target, and less elder patients were current smokers or were obese. About 17\% of patients on average had CKD (eGFR< 60 ml/min/1.73m²) in the entire European sample at the study visit, and an additional 10\% had albuminuria despite preserved eGFR, with considerable variation among countries. Impaired kidney function was observed in every fifth patient admitted for CHD in the entire European dataset of the EUROASPIRE IV study. Of the German CHD patients with CKD at the study visit, only a third were aware of their renal impairment. A minority of these patients was being seen by nephrologists, however, with a higher likelihood of CKD awareness and specialist care in more advanced stages of CKD. About a third of patients admitted for CHD showed either CKD or AKI during the hospital stay, but the discharge letter mentioned chronic or acute kidney disease only in every fifth of these patients. In contrast, correct ICD coding of CKD or AKI was more complete, but still suboptimal. In summary, quality of secondary prevention in German CHD patients indicates considerably room for improvement, with life-style modifications may become an even greater factor in prevention campaigns than medical treatment into certain target ranges. Preventive therapies should also consider different needs in older individuals acknowledging physical and mental potential, other comorbidities and drug-interactions with co-medication. CKD is common in CHD patients, not only in the elderly. Since CHD and CKD affect each other and impact on worse prognosis of each other, raising the awareness of CKD among patients and physicians and considering CKD in medical therapy may improve prognosis and slow disease progression of CHD as well as CKD.}, language = {en} } @phdthesis{vonderHeide2024, author = {von der Heide, Julia Magdalena}, title = {Ist eine Berechnung der Geometrie der Halswirbelk{\"o}rper anhand ihrer Morphologie im Kindesalter und somit eine Individualisierung der CVM-Methode m{\"o}glich?}, doi = {10.25972/OPUS-36075}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-360753}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Ziel der vorliegenden Studie war es zu untersuchen, ob anhand geometrischer Merkmale der HWK im Kindesalter eine sichere individuelle Vorhersage der Morphologie der HWK zum Ende der Entwicklung m{\"o}glich ist. Hierdurch k{\"o}nnte eine Individualisierung der CVM-Methode und somit eine Einsch{\"a}tzung des bereits verstrichenen Wachstums erfolgen. Zu diesem Zweck wurden insgesamt 1377 FRS-Aufnahmen von 267 Patienten - 110 weibliche und 157 m{\"a}nnliche - aus dem Archiv der Poliklinik f{\"u}r Kieferorthop{\"a}die des Universit{\"a}tsklinikums W{\"u}rzburg digitalisiert und untersucht. Die HWK wurden im Programm OnyxCeph (Herst.: Image Instruments GmbH) quantifiziert und die berechneten Werte mit der Software SPSS statistisch ausgewertet. Mittels linearer Regressionen wurde versucht, anhand der Morphologie der Wirbelk{\"o}rper vor dem puberalen Wachstumsschub auf die Geometrie der HWK im Erwachsenenalter zu schließen. Zur Illustrierung wurden Streudiagramm und die dazugeh{\"o}rigen Abfolgen von R{\"o}ntgenbildern dargestellt. Eine Sch{\"a}tzung der Geometrie der HWK im Erwachsenenalter w{\"u}rde bei den separat betrachteten Parametern und bei einer gemeinsamen Betrachtung der Parameter kaum zu korrekten Einsch{\"a}tzungen f{\"u}hren. Die Streudiagramme mit den Bilderabfolgen st{\"u}tzen diese These ebenfalls und illustrieren die m{\"o}gliche Fehleinsch{\"a}tzung der Geometrie. Die Ergebnisse der Studie zeigen erneut, dass die Geometrie der HWK im Erwachsenenalter sehr variabel ist, wie komplex die Entwicklung der HWK ist und dass anhand ihrer Geometrie im Kindesalter keine sichere Einsch{\"a}tzung der skelettalen Reife m{\"o}glich ist. Eine Individualisierung der CVM-Methode ist anhand der in dieser Studie untersuchten Parameter nicht m{\"o}glich. Somit l{\"a}sst sich schlussfolgern, dass die CVM-Methode nicht als alleinige Methode zur pr{\"a}zisen skelettalen Alterseinsch{\"a}tzung verl{\"a}sslich genutzt werden kann, sondern f{\"u}r eine sichere Beurteilung weitere Reifeindikatoren hinzugezogen werden sollten. Allerdings sollten hierzu zus{\"a}tzliche radiologische Untersuchungen, wie beispielsweise die Handr{\"o}ntgenaufnahme, nur dann durchgef{\"u}hrt werden, wenn diese dem ALARA-Prinzip entsprechen.}, subject = {Skelett}, language = {de} } @article{VollmuthMuljukovAbuMugheisibetal.2021, author = {Vollmuth, Christoph and Muljukov, Olga and Abu-Mugheisib, Mazen and Angermeier, Anselm and Barlinn, Jessica and Busetto, Loraine and Grau, Armin J. and G{\"u}nther, Albrecht and Gumbinger, Christoph and Hubert, Nikolai and H{\"u}ttemann, Katrin and Klingner, Carsten and Naumann, Markus and Palm, Frederick and Remi, Jan and R{\"u}cker, Viktoria and Schessl, Joachim and Schlachetzki, Felix and Schuppner, Ramona and Schwab, Stefan and Schwartz, Andreas and Trommer, Adrian and Urbanek, Christian and Volbers, Bastian and Weber, Joachim and Wojciechowski, Claudia and Worthmann, Hans and Zickler, Philipp and Heuschmann, Peter U. and Haeusler, Karl Georg and Hubert, Gordian Jan}, title = {Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020}, series = {European Journal of Neurology}, volume = {28}, journal = {European Journal of Neurology}, number = {10}, doi = {10.1111/ene.14787}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259396}, pages = {3267-3278}, year = {2021}, abstract = {Background and purpose The effects of the coronavirus disease 2019 (COVID-19) pandemic on telemedical care have not been described on a national level. Thus, we investigated the medical stroke treatment situation before, during, and after the first lockdown in Germany. Methods In this nationwide, multicenter study, data from 14 telemedical networks including 31 network centers and 155 spoke hospitals covering large parts of Germany were analyzed regarding patients' characteristics, stroke type/severity, and acute stroke treatment. A survey focusing on potential shortcomings of in-hospital and (telemedical) stroke care during the pandemic was conducted. Results Between January 2018 and June 2020, 67,033 telemedical consultations and 38,895 telemedical stroke consultations were conducted. A significant decline of telemedical (p < 0.001) and telemedical stroke consultations (p < 0.001) during the lockdown in March/April 2020 and a reciprocal increase after relaxation of COVID-19 measures in May/June 2020 were observed. Compared to 2018-2019, neither stroke patients' age (p = 0.38), gender (p = 0.44), nor severity of ischemic stroke (p = 0.32) differed in March/April 2020. Whereas the proportion of ischemic stroke patients for whom endovascular treatment (14.3\% vs. 14.6\%; p = 0.85) was recommended remained stable, there was a nonsignificant trend toward a lower proportion of recommendation of intravenous thrombolysis during the lockdown (19.0\% vs. 22.1\%; p = 0.052). Despite the majority of participating network centers treating patients with COVID-19, there were no relevant shortcomings reported regarding in-hospital stroke treatment or telemedical stroke care. Conclusions Telemedical stroke care in Germany was able to provide full service despite the COVID-19 pandemic, but telemedical consultations declined abruptly during the lockdown period and normalized after relaxation of COVID-19 measures in Germany.}, language = {en} } @article{UnnikrishnanSchleicherShahetal.2020, author = {Unnikrishnan, Vishnu and Schleicher, Miro and Shah, Yash and Jamaludeen, Noor and Pryss, Ruediger and Schobel, Johannes and Kraft, Robin and Schlee, Winfried and Spiliopoulou, Myra}, title = {The effect of non-personalised tips on the continued use of self-monitoring mHealth applications}, series = {Brain Sciences}, volume = {10}, journal = {Brain Sciences}, number = {12}, issn = {2076-3425}, doi = {10.3390/brainsci10120924}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219435}, year = {2020}, abstract = {Chronic tinnitus, the perception of a phantom sound in the absence of corresponding stimulus, is a condition known to affect patients' quality of life. Recent advances in mHealth have enabled patients to maintain a 'disease journal' of ecologically-valid momentary assessments, improving patients' own awareness of their disease while also providing clinicians valuable data for research. In this study, we investigate the effect of non-personalised tips on patients' perception of tinnitus, and on their continued use of the application. The data collected from the study involved three groups of patients that used the app for 16 weeks. Groups A \& Y were exposed to feedback from the start of the study, while group B only received tips for the second half of the study. Groups A and Y were run by different supervisors and also differed in the number of hospital visits during the study. Users of Group A and B underwent assessment at baseline, mid-study, post-study and follow-up, while users of group Y were only assessed at baseline and post-study. It is seen that the users in group B use the app for longer, and also more often during the day. The answers of the users to the Ecological Momentary Assessments are seen to form clusters where the degree to which the tinnitus distress depends on tinnitus loudness varies. Additionally, cluster-level models were able to predict new unseen data with better accuracy than a single global model. This strengthens the argument that the discovered clusters really do reflect underlying patterns in disease expression.}, language = {en} } @article{UngethuemWiedmannWagneretal.2023, author = {Ungeth{\"u}m, K. and Wiedmann, S. and Wagner, M. and Leyh, R. and Ertl, G. and Frantz, S. and Geisler, T. and Karmann, W. and Prondzinsky, R. and Herdeg, C. and Noutsias, M. and Ludwig, T. and K{\"a}s, J. and Klocke, B. and Krapp, J. and Wood, D. and Kotseva, K. and St{\"o}rk, S. and Heuschmann, P. U.}, title = {Secondary prevention in diabetic and nondiabetic coronary heart disease patients: insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys}, series = {Clinical Research in Cardiology}, volume = {112}, journal = {Clinical Research in Cardiology}, number = {2}, doi = {10.1007/s00392-022-02093-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324037}, pages = {285-298}, year = {2023}, abstract = {Background Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. Methods The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in W{\"u}rzburg (EA-IV, EA-V), Halle (EA-V), and T{\"u}bingen (EA-V). Results 384 EA-V participants (median age 69.0 years, 81.3\% male) and 536 EA-IV participants (median age 68.7 years, 82.3\% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8\% vs. 19.6\%) while the proportion of prediabetes was similarly high in the remaining population (62.1\% vs. 61.0\%). Conclusion Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel and Kunze, Claudia and Dietzel, Joanna and Schurig, Johannes and Fiessler, Cornelia and Malsch, Carolin and Haas, Tobias Eberhard and Dimitrijeski, Boris and Doehner, Wolfram and Hagemann, Georg and Hamilton, Frank and Honermann, Martin and Jungehulsing, Gerhard Jan and Kauert, Andreas and Koennecke, Hans-Christian and Mackert, Bruno-Marcel and Nabavi, Darius and Nolte, Christian H. and Reis, Joschua Mirko and Schmehl, Ingo and Sparenberg, Paul and Stingele, Robert and V{\"o}lzke, Enrico and Waldschmidt, Carolin and Zeise-Wehry, Daniel and Heuschmann, Peter U. and Endress, Matthias and Haeusler, Karl Georg}, title = {Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry}, series = {Journal of Neurology}, volume = {269}, journal = {Journal of Neurology}, number = {1}, issn = {1432-1459}, doi = {10.1007/s00415-021-10866-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266969}, pages = {470-480}, year = {2022}, abstract = {Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5\%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8\%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95\% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95\% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2\%) of 61 patients. Overall, 79 (13.7\%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6\%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95\% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95\% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95\% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95\% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel C. and Kunze, Claudia and Kr{\"a}mer, Michael and Dietzel, Joanna and Schurig, Johannes and Filser, Paula and Pfeilschifter, Waltraud and Hamann, Gerhard F. and B{\"u}ttner, Thomas and Heuschmann, Peter U. and Kirchhof, Paulus and Laufs, Ulrich and Nabavi, Darius G. and R{\"o}ther, Joachim and Thomalla, G{\"o}tz and Veltkamp, Roland and Eckardt, Kai-Uwe and Haeusler, Karl Georg and Endres, Matthias}, title = {Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack}, series = {European Journal of Neurology}, volume = {29}, journal = {European Journal of Neurology}, number = {9}, doi = {10.1111/ene.15431}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287271}, pages = {2716 -- 2724}, year = {2022}, abstract = {Background and purpose Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction. Methods The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD-EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m\(^{2}\). eGFR dynamics were classified based on two in-hospital values as "stable normal" (≥60 ml/min/1.73 m\(^{2}\)), "increasing" (by at least 15\% from baseline, second value ≥ 60 ml/min/1.73 m\(^{2}\)), "decreasing" (by at least 15\% from baseline of ≥60 ml/min/1.73 m\(^{2}\)), and "stable decreased" (<60 ml/min/1.73 m\(^{2}\)). The composite endpoint (stroke, major bleeding, myocardial infarction, all-cause death) was assessed after 24 months. We estimated hazard ratios in confounder-adjusted models. Results Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m\(^{2}\) at baseline (hazard ratio [HR] = 2.2, 95\% confidence interval [CI] = 1.40-3.54) as well as decreasing (HR = 1.79, 95\% CI = 1.07-2.99) and stable decreased eGFR (HR = 1.64, 95\% CI = 1.20-2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95\% CI = 1.51-6.10) and decreasing eGFR were associated with all-cause death (HR = 3.12, 95\% CI = 1.63-5.98). Conclusions In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.}, language = {en} }