15838
2017
eng
321
18
article
1
2018-03-02
--
--
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
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.
BMC Nephrology
10.1186/s12882-017-0730-3
urn:nbn:de:bvb:20-opus-158387
BMC Nephrology (2017) 18:321. DOI: 10.1186/s12882-017-0730-3
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Martin Wagner
Christoph Wanner
Martin Schich
Kornelia Kotseva
David Wood
Katrin Hartmann
Georg Fette
Viktoria Rücker
Mehmet Oezkur
Stefan Störk
Peter U. Heuschmann
eng
uncontrolled
coronary heart disease
eng
uncontrolled
ICD-coding of CKD
eng
uncontrolled
chronic kidney disease
eng
uncontrolled
patients’ awareness
eng
uncontrolled
physicians’ awareness
eng
uncontrolled
EUROASPIRE survey
Krankheiten
open_access
Institut für Informatik
Klinik und Poliklinik für Thorax-, Herz- u. Thorakale Gefäßchirurgie
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15838/Wagner_BMC_Nephrology.pdf
25939
2021
eng
3267–3278
10
28
article
1
--
--
--
Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020
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.
European Journal of Neurology
10.1111/ene.14787
urn:nbn:de:bvb:20-opus-259396
publish
European Journal of Neurology 2021, 28(10):3267–3278. DOI: 10.1111/ene.14787
false
true
CC BY-NC-ND: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell, Keine Bearbeitungen 4.0 International
Christoph Vollmuth
Olga Muljukov
Mazen Abu-Mugheisib
Anselm Angermeier
Jessica Barlinn
Loraine Busetto
Armin J. Grau
Albrecht Günther
Christoph Gumbinger
Nikolai Hubert
Katrin Hüttemann
Carsten Klingner
Markus Naumann
Frederick Palm
Jan Remi
Viktoria Rücker
Joachim Schessl
Felix Schlachetzki
Ramona Schuppner
Stefan Schwab
Andreas Schwartz
Adrian Trommer
Christian Urbanek
Bastian Volbers
Joachim Weber
Claudia Wojciechowski
Hans Worthmann
Philipp Zickler
Peter U. Heuschmann
Karl Georg Haeusler
Gordian Jan Hubert
eng
uncontrolled
COVID-19
eng
uncontrolled
SARS-CoV- 2
eng
uncontrolled
stroke
eng
uncontrolled
telemedicine
eng
uncontrolled
survey
Medizin und Gesundheit
open_access
Institut für Klinische Neurobiologie
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/25939/Vollmuth_Neurology.pdf
15939
2017
eng
276
17
article
1
2018-03-20
--
--
Control of cardiovascular risk factors and its determinants in the general population – findings from the STAAB cohort study
Background:
While data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD).
Methods:
Data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed.
Results:
Between December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11).
Conclusions:
In the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population.
BMC Cardiovascular Disorders
10.1186/s12872-017-0708-x
urn:nbn:de:bvb:20-opus-159391
BMC Cardiovascular Disorders (2017) 17:276. DOI: 10.1186/s12872-017-0708-x
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Theresa Tiffe
Martin Wagner
Viktoria Rücker
Caroline Morbach
Götz Gelbrich
Stefan Störk
Peter U. Heuschmann
eng
uncontrolled
population-based study
eng
uncontrolled
prevalence
eng
uncontrolled
risk factor control
eng
uncontrolled
guideline adherence
eng
uncontrolled
primary prevention
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15939/Tiffe_Cardiovascular_Disorders.pdf
20099
2019
eng
9385397
2019
article
1
2020-03-09
--
--
Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study
Background.
Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension.
Methods.
We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication.
Results.
Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model.
Conclusion.
Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.
International Journal of Hypertension
10.1155/2019/9385397
urn:nbn:de:bvb:20-opus-200992
International Journal of Hypertension (2019) 2019, 9385397. https://doi.org/10.1155/2019/9385397
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Theresa Tiffe
Caroline Morbach
Viktoria Rücker
Götz Gelbrich
Martin Wagner
Hermann Faller
Stefan Störk
Peter U. Heuschmann
eng
uncontrolled
hypertension
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Förderzeitraum 2019
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/20099/Tiffe_InternationalJournalOfHypertension_2019.pdf.pdf
16680
2016
eng
e0162188
9
11
article
1
2018-08-07
--
--
Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts
Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.
PLoS ONE
10.1371/journal.pone.0162188
urn:nbn:de:bvb:20-opus-166804
PLoS ONE 11(9):e0162188 (2016). DOI: 10.1371/journal.pone.0162188
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Viktoria Rücker
Ulrich Keil
Anthony P Fitzgerald
Uwe Malzahn
Christof Prugger
Georg Ertl
Peter U Heuschmann
Hannelore Neuhauser
eng
uncontrolled
fatal cardiovascular disease
eng
uncontrolled
SCORE
eng
uncontrolled
Germany
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/16680/Ruecker_PLoS_ONE.PDF
23311
2021
eng
doctoralthesis
1
2021-04-05
--
2021-04-06
Time trends and determinants of stroke mortality in Germany
Zeitliche Trends und Einflussfaktoren auf die Schlaganfall-Sterblichkeit in Deutschland
In several countries, a decline in mortality, case-fatality and recurrence rates of stroke was observed. However, studies investigating sex-specific and subtype-specific (pathological and etiological) time trends in stroke mortality, case-fatality and recurrence rates are scarce, especially in Germany. The decline in ischemic stroke mortality and case-fatality might be associated with the high quality of acute care of ischemic stroke, but the exact determinants of early outcome remains unknown for Germany.
Therefore, as first step of this thesis, we investigated the time trends of subtype- and sex-specific age- standardized stroke mortality rates in Germany from 1998 to 2015, by applying joinpoint regression on official causes of death statistics, provided by the Federal Statistical Office. Furthermore, a regional comparison of the time trends in stroke mortality between East and West was conducted. In the second step, time trends in case-fatality and stroke recurrence rates were analyzed using data from a population- based stroke register in Germany between 1996 and 2015. The analysis was stratified by sex and etiological subtype of ischemic stroke. In the third step, quality of stroke care and the association between adherence to measures of quality of acute ischemic stroke care and in-hospital mortality was estimated based on data from nine regional hospital-based stroke registers in Germany from the years 2015 and 2016.
We showed that in Germany, age-standardized stroke mortality declined by over 50% from 1998 to 2015 both, in women and men. Stratified by the pathological subtypes of stroke, the decrease in mortality was larger in ischemic stroke compared to hemorrhagic stroke. Different patterns in the time trends of stroke were observed for stroke subtypes, regions in Germany (former Eastern part of Germany (EG), former Western part of Germany (WG)) and sex, but in all strata a decline was found. By applying joinpoint regression, the number of changes in time trend differed between the regions and up to three changes in the trend in ischemic stroke mortality were detected. Trends in hemorrhagic stroke were in parallel between the regions with up to one change (in women) in joinpoint regression. Comparing the regions, stroke mortality was higher in EG compared to WG throughout the whole observed time period, however the differences between the regions started to diminish from 2007 onwards.
Further it was found that, based on the population-based Erlangen Stroke Project (ESPro), case-fatality and recurrence rates in ischemic stroke patients are still high in Germany. 46% died and 20% got a recurrent stroke within the first five years after stroke. Case-fatality rates declined statistically significant from 1996 to 2015 across all ischemic stroke patients and all etiological subtypes of ischemic stroke. Based on Cox regression no statistically significant decrease in stroke recurrence was observed.
Based on the pooled data of nine regional hospital-based stroke registers from the years 2015 and 2016 covering about 80% of all hospitalized stroke patients in Germany, a high quality of care of acute ischemic stroke patients, measured via 11 evidence-based quality indicators (QI) of process of care, was observed. Across all registers, most QI reached the predefined target values for good quality of stroke care. 9 out of 11 QI showed a significant association with 7-day in-hospital mortality. An inverse linear association between overall adherence to QI and 7-day in-hospital mortality was observed.
In conclusion, stroke mortality and case-fatality showed a favorable development over time in Germany, which might partly be due to improvements in acute treatment. This is supported by the association between overall adherence to quality of care and in-hospital mortality. However, there might be room for improvements in long-term secondary prevention, as no clear reduction in recurrence rates was observed.
Ein Rückgang der Mortalität-, Letalität- und Rezidivraten nach einem Schlaganfall konnte in einigen Ländern in den letzten Jahren beobachtet werden. Es gibt, insbesondere für Deutschland, jedoch nur wenige Daten, die diese zeitlichen Trends stratifiziert nach Geschlecht und Schlaganfallsubtyp (pathologischer und ätiologischer Subtyp) ausgewertet haben. Der Rückgang der Mortalität und Letalität nach ischämischem Schlaganfall könnte mit der beobachteten hohen Qualität der Versorgung des akuten ischämischen Schlaganfalls zusammenhängen, jedoch sind für Deutschland die genauen Determinanten der frühen Sterblichkeit nach Schlaganfall noch unbekannt.
Aus diesem Grunde wurden in der vorliegenden Dissertation, im ersten Schritt zeitliche Trends von 1998 bis 2015 der altersstandardisierten und nach Subtyp und Geschlecht stratifizierten Mortalitätsraten untersucht. Dazu wurden die vom Statistischen Bundesamtes bereitgestellten Daten zur Todesursachenstatistik mittels Joinpoint Regression ausgewertet. Zusätzlich wurde ein regionaler Vergleich der zeitlichen Trends in der Schlaganfallmortalität zwischen der östlichen und westlichen Region von Deutschland durchgeführt. Im zweiten Schritt, wurde basierend auf einem deutschem bevölkerungsbasierten Schlaganfallregister mittels Cox Regression die zeitlichen Trends der Letalitätsraten und Rezidivraten des ischämischen Schlaganfalls zwischen 1996 und 2015 geschätzt. Die Analyse wurde stratifiziert nach Geschlecht und ätiologischem Subtyp des ischämischen Schlaganfalls. Im dritten Schritt wurde, basierend auf Daten von neun regionalen krankenhausbasierten Schlaganfallregistern der Jahre 2015 und 2016, die Qualität der Behandlung des akuten ischämischen gemessen und ein möglicher Zusammenhang zwischen dem Grad der Erfüllung von evidenzbasierten Qualitätsindikatoren und der Krankenhaussterblichkeit untersucht.
Wir konnten zeigen, dass von 1998 bis 2015 die altersstandardisierten Schlaganfall Mortalitätsraten über 50%, sowohl bei Männern als auch bei Frauen, abgenommen haben. Stratifiziert nach pathologischem Schlaganfallsubtyp zeigte sich ein stärkerer Rückgang in den Mortalitätsraten nach ischämischem Schlaganfall als in der Mortalitätsrate nach hämorrhagischem Schlaganfall. In allen Strata sind die Mortalitätsraten gesunken, jedoch unterschieden sich die zeitlichen Verläufe zwischen den Strata
(Geschlecht, Region). Die mittels Joinpoint Regression geschätzten Anzahlen an Änderungen im zeitlichen Trend der ischämischen Schlaganfall Mortalitätsraten variierten zwischen 0 und maximal 3 Änderungen, zwischen den Regionen und Geschlechtern. Die zeitlichen Trends der Mortalitätsraten nach hämorrhagischem Schlaganfall der beiden Regionen verliefen hingegen parallel zueinander und es zeigte sich nur bei Frauen eine Änderung in der Mortalitätsrate nach der Joinpoint Regression. Die Schlaganfall Mortalitätsraten im östlichen Teil von Deutschland waren über die gesamte Zeit hinweg höher als im westlichen Teil von Deutschland, jedoch glichen sich die Raten ab 2007 immer mehr einander an und es zeigte sich nur noch ein geringer Unterschied in 2015.
Die altersadjustierten Letalitätsraten und Rezidivraten nach ischämischem Schlaganfall waren in Deutschland, basierend auf Daten des bevölkerungsbasierten Erlanger Schlaganfall Registers, relativ hoch. Innerhalb der ersten fünf Jahre nach einem ischämischen Schlaganfall sterben 46% und 20% aller Patienten bekommen einen erneuten Schlaganfall. Von 1996 bis 2015 haben die Letalitätsraten nach Schlaganfall signifikant abgenommen, dies zeigte sich in allen Subtypen des ischämischen Schlaganfalls. Die Rezidivraten zeigten keinen signifikanten Rückgang.
Basierend auf gepoolten Daten aus den Jahren 2015/2016 von neun krankenhausbasierten Schlaganfall Registern in Deutschland, die ca. 80% aller hospitalisierten Schlaganfälle in Deutschland abdecken, ist die, mittels 11 evidenzbasierter Prozessindikatoren gemessene Qualität der Behandlung des ischämischen Schlaganfalls, hoch. In allen Registern lagen die meisten Qualitätsindikatoren über dem vorabdefinierten Referenzwert für eine gute Qualität an Schlaganfallversorgung. Ein Zusammenhang zwischen 7-Tage Krankenhaussterblichkeit und Erfüllung von einzelnen Qualitätsindikatoren, konnte bei 9 von 11 Qualitätsindikatoren gezeigt werden. Zusätzlich zeigte sich ein inverser Zusammenhang zwischen der Gesamteinhaltung von Qualitätsindikatoren und 7-Tage Krankenhaussterblichkeit.
Schlaganfall Mortalitätsrate und Letalitätsraten zeigten eine positive Entwicklung in allen Subtypen des Schlaganfalls über die letzten 20 Jahre. Dies könnte mit Verbesserungen in der Behandlung des akuten ischämischen Schlaganfalls im Krankenhaus zusammenhängen, da ein Zusammenhang zwischen der Erfüllung von Qualitätsindikatoren und der Krankenhaussterblichkeit besteht. Jedoch besteht
möglicherweise noch Verbesserungspotenzial in der langfristigen Sekundärprävention, da in den Rezidivraten kein klarer Rückgang erkennbar war.
urn:nbn:de:bvb:20-opus-233116
10.25972/OPUS-23311
publish
X 129601
CC BY-NC-ND: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell, Keine Bearbeitungen 4.0 International
Viktoria Rücker
deu
swd
Schlaganfall
deu
swd
Sterblichkeit
deu
swd
Rezidiv
deu
swd
Letalität
deu
swd
Trend
deu
uncontrolled
Qualitätsindikator
Medizin und Gesundheit
open_access
Graduate School of Life Sciences
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/23311/Ruecker_Viktoria_TimeTrendStroke.pdf
20072
2019
eng
84
19
article
1
2020-03-06
--
--
Segment-specific association of carotid-intima-media thickness with cardiovascular risk factors – findings from the STAAB cohort study
Background
The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors.
Methods
Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from Würzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT.
Results
2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA.
Conclusions
As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual.
BMC Cardiovascular Disorders
10.1186/s12872-019-1044-0
urn:nbn:de:bvb:20-opus-200720
BMC Cardiovascular Disorders (2019), 19:84. https://doi.org/10.1186/s12872-019-1044-0
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Lara Müller-Scholden
Jan Kirchhof
Caroline Morbach
Margret Breunig
Rudy Meijer
Viktoria Rücker
Theresa Tiffe
Tino Yurdadogan
Martin Wagner
Götz Gelbrich
Michiel L. Bots
Stefan Störk
Peter U. Heuschmann
eng
uncontrolled
Carotid intima-media thickness (CIMT)
eng
uncontrolled
Carotid segment
eng
uncontrolled
Carotid ultrasound
eng
uncontrolled
Cardiovascular risk factors
eng
uncontrolled
Cardiovascular risk prediction
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Förderzeitraum 2019
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/20072/Mueller-Scholden_BMCCardiovascularDisorders_2019.pdf
30011
2022
eng
1
22
article
1
--
--
--
Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study
Background
Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables.
Methods
Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, Würzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L.
Results
We report results from 543 IS patients recruited between 01/2014–02/2017. Of those, 203 (37%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95% CI 1.02–1.08), male sex (OR 2.65; 95% CI 1.54–4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m2 0.71; 95% CI 0.61–0.84), systolic dysfunction (OR 2.79; 95% CI 1.22–6.37), diastolic dysfunction (OR 2.29; 95% CI 1.29–4.02), atrial fibrillation (OR 2.30; 95% CI 1.25–4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95% CI 1.22–1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables.
Conclusion
Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors.
BMC Neurology
10.1186/s12883-022-03017-1
urn:nbn:de:bvb:20-opus-300119
@articleMontellano.2022, author = Montellano, Felipe A. and Kluter, Elisabeth J. and Rücker, Viktoria and Ungethüm, Kathrin and Mackenrodt, Daniel and Wiedmann, Silke and Dege, Tassilo and Quilitzsch, Anika and Morbach, Caroline and Frantz, Stefan and Störk, Stefan and Haeusler, Karl Georg and Kleinschnitz, Christoph and Heuschmann, Peter U., year = 2022, title = Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study, pages = 511, volume = 22, number = 1, journal = BMC neurology, doi = 10.1186/s12883-022-03017-1,
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2023-01-19T06:57:20+00:00
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bibtex
63c8e9d0519074.51406195
BMC Neurology 2022, 22(1):511. DOI: 10.1186/s12883-022-03017-1
false
true
Felipe A. Montellano
Elisabeth J. Kluter
Viktoria Rücker
Kathrin Ungethüm
Daniel Mackenrodt
Silke Wiedmann
Tassilo Dege
Anika Quilitzsch
Caroline Morbach
Stefan Frantz
Stefan Störk
Karl Georg Haeusler
Christoph Kleinschnitz
Peter U. Heuschmann
eng
uncontrolled
echocardiography
eng
uncontrolled
ischemic stroke
eng
uncontrolled
troponin
eng
uncontrolled
heart failure
eng
uncontrolled
biomarkers
Medizin und Gesundheit
open_access
Neurologische Klinik und Poliklinik
Medizinische Klinik und Poliklinik I
Institut für Klinische Epidemiologie und Biometrie
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Förderzeitraum 2022
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/30011/BMC_Neurology_Montellano.pdf
15808
2017
eng
159
17
article
1
2018-02-26
--
--
Feasibility and diagnostic accuracy of point-of-care handheld echocardiography in acute ischemic stroke patients - a pilot study
Background:
Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting.
Methods:
IS patients were recruited on the SU of the University Hospital Würzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF). Diagnostic agreement was assessed by comparing POC with SE executed by an expert sonographer, and intraclass correlation coefficient (ICC) or kappa (κ) with 95% confidence intervals (95% CI) were calculated.
Results:
In the 78 patients receiving both POC and SE agreement for cardiac parameters was good, with ICC varying from 0.82 (95% CI 0.71–0.89) to 0.93 (95% CI 0.87–0.96), and κ from 0.39 (−95% CI 0.14–0.92) to 0.79 (95% CI 0.67–0.91). Detection of systolic dysfunction with POC echocardiography compared to SE was very good, with an area under the curve of 0.99 (0.96–1.00). Interrater agreement for LVEF measured by POC echocardiography was good with κ 0.63 (95% CI 0.40–0.85).
Conclusions:
POC echocardiography in a SU setting is feasible enabling reliable quantification of LVEF and preliminary assessment of selected cardiac parameters that might be used for research purposes. Its potential clinical utility in triaging stroke patients who should undergo or do not necessarily require SE needs to be investigated in larger prospective diagnostic studies.
BMC Neurology
10.1186/s12883-017-0937-8
urn:nbn:de:bvb:20-opus-158081
BMC Neurology (2017) 17:159. DOI: 10.1186/s12883-017-0937-8
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Peter Kraft
Anna Fleischer
Silke Wiedmann
Viktoria Rücker
Daniel Mackenrodt
Caroline Morbach
Uwe Malzahn
Christoph Kleinschnitz
Stefan Störk
Peter U. Heuschmann
eng
uncontrolled
ischemic stroke
eng
uncontrolled
systolic dysfunction
eng
uncontrolled
point-of-care echocardiography
eng
uncontrolled
ejection fraction
eng
uncontrolled
stroke unit
eng
uncontrolled
feasibility
eng
uncontrolled
accuracy
Krankheiten
open_access
Neurologische Klinik und Poliklinik
Abteilung für Molekulare Innere Medizin (in der Medizinischen Klinik und Poliklinik II)
Institut für Klinische Epidemiologie und Biometrie
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15808/Kraft_BMC_Neurology.pdf
15944
2017
eng
49
17
article
German Stroke Register Study Group (ADSR)
1
2018-03-21
--
--
Stroke unit care in Germany: the German stroke registers study group (ADSR)
Background:
Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.
Methods:
Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.
Results:
In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.
Conclusions:
Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
BMC Neurology
10.1186/s12883-017-0819-0
urn:nbn:de:bvb:20-opus-159447
BMC Neurology (2017) 17:49. DOI: 10.1186/s12883-017-0819-0
223153
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Steffi Hillmann
Silke Wiedmann
Viktoria Rücker
Klaus Berger
Darius Nabavi
Ingo Bruder
Hans-Christian Koennecke
Günter Seidel
Björn Misselwitz
Alfred Janssen
Christoph Burmeister
Christine Matthis
Otto Busse
Peter Hermanek
Peter Ulrich Heuschmann
eng
uncontrolled
stroke register
eng
uncontrolled
stroke unit care
eng
uncontrolled
quality of health care
eng
uncontrolled
quality indicators
Krankheiten
open_access
Institut für Klinische Epidemiologie und Biometrie
OpenAIRE
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15944/Hillmann_BMC_Neurology.pdf