12188
2013
eng
180
14
article
1
2015-11-12
--
--
Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study
Background: International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the association between the recognition of current depression/anxiety by the general practitioner (GP) and the quality of life and the patients' prognosis.
Methods/Design: In this multicenter, prospective, observational study 3,950 patients with HF are recruited by general practices in Germany. The patients fill out questionnaires at baseline and 12-month follow-up. At baseline the GPs are interviewed regarding the somatic and psychological comorbidities of their patients. During the follow-up assessment, data on hospitalization and mortality are provided by the general practice. Based on baseline data, the patients are allocated into three observation groups: HF patients with depression and/or anxiety recognized by their GP (P+/+), those with depression and/or anxiety not recognized (P+/-) and patients without depression and/or anxiety (P-/-). We will perform multivariate regression models to investigate the influence of the recognition of depression and/or anxiety on quality of life at 12 month follow-up, as well as its influences on the prognosis (hospital admission, mortality).
Discussion: We will display the frequency of GP-acknowledged depression and anxiety and the frequency of installed therapeutic strategies. We will also describe the frequency of depression and anxiety missed by the GP and the resulting treatment gap. Effects of correctly acknowledged and missed depression/anxiety on outcome, also in comparison to the outcome of subjects without depression/anxiety will be addressed. In case results suggest a treatment gap of depression/anxiety in patients with HF, the results of this study will provide methodological advice for the efficient planning of further interventional research.
BMC Family Practice
10.1186/1471-2296-14-180
1471-2296
urn:nbn:de:bvb:20-opus-121881
BMC Family Practice 2013, 14:180. doi:10.1186/1471-2296-14-180
Marion Eisele
Eva Blozik
Stefan Störk
Jens-Martin Träder
Christoph Herrmann-Lingen
Martin Scherer
eng
uncontrolled
anxiety
eng
uncontrolled
depression
eng
uncontrolled
health care research
eng
uncontrolled
heart failure
eng
uncontrolled
prevalence
eng
uncontrolled
observational study
eng
uncontrolled
prognosis
eng
uncontrolled
quality of life
eng
uncontrolled
hospitalization
eng
uncontrolled
treatment
eng
uncontrolled
mortality
eng
uncontrolled
task force
eng
uncontrolled
health questionnaire
eng
uncontrolled
cardiovascular care
eng
uncontrolled
validity
eng
uncontrolled
scale
eng
uncontrolled
validation
eng
uncontrolled
outcomes
eng
uncontrolled
standardization
eng
uncontrolled
population
Krankheiten
open_access
Medizinische Klinik und Poliklinik I
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/12188/006_Eisele_BMC_Family_Practice.pdf
12119
2014
eng
12
article
1
2015-10-28
--
--
Position paper on the importance of psychosocial factors in cardiology: Update 2013
Positionspapier zur Bedeutung psychosozialer Faktoren in der
Kardiologie: Update 2013
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008.
Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients.
Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered.
Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
Hintergrund: Die rasche Weiterentwicklung der psychokardiologischen Forschung, aber auch die wachsende Verankerung psychosozialer Fragestellungen im klinischen Alltag haben die Klinische Kommission der DGK bewogen, einer Aktualisierung und Weiterentwicklung des 2008 erstmals publizierten Positionspapiers zur Bedeutung psychosozialer Faktoren in der Kardiologie zuzustimmen.
Methoden: Der Kreis der Autoren wurde vergrößert, allgemeine Aspekte eingefügt und das Wissen in allen Abschnitten auf den heutigen Stand gebracht. Schwerpunkte der Empfehlungen sind die koronare Herzerkrankung, Herzrhythmusstörungen und die Herzinsuffizienz, da hier der Stand der empirischen Evidenz und des klinisches Wissens zu psychosozialen Fragestellungen am weitesten entwickelt ist. Berücksichtigt wurden bei den Empfehlungen Besonderheiten von Frauen und Männern, Unterschiede bzgl. der Lebensspanne, Einflüsse auf die kognitive Leistungsfähigkeit und die interaktive synergistische Bedeutung klassischer Risikofaktoren bei affektiver Komorbidität.
Ergebnisse: Eine I-A-Empfehlung (Empfehlungsgrad I, Evidenzgrad A) wurde vergeben für die Aufforderung, psychosoziale Risikofaktoren bei der Einschätzung des KHK-Risikos zu berücksichtigen, die als unabhängige ätiologische und prognostische Risikofaktoren für das Auftreten der koronaren Herzerkrankung (KHK) und für Komplikationen im Behandlungsverlauf der KHK bedeutsam sind. Ferner für die Empfehlung, Patienten mit Herzoperationen von einem interdisziplinären Team zu betreuten, in dem die Möglichkeit besteht, auf psychosoziale Aspekte einzugehen, da bei diesen Patienten komorbide psychische Störungen wie Depressivität, Angst und posttraumatische Belastungsstörung häufig und prognostisch ungünstig sind. Eine I-B-Empfehlung wurde vergeben für die Behandlung psychosozialer Risikofaktoren mit dem Ziel einer Primärprävention der KHK, wenn das Risikomerkmal an sich Krankheitswert hat (z. B. Depression) oder die Behandlung klassischer Risikofaktoren erschwert ist. Eine antidepressive Pharmakotherapie soll Patienten nach akutem Koronarsyndrom sowie in der Phase der chronischen KHK angeboten werden, die an einer mindestens mittelschweren rezidivierenden depressiven Störung leiden. Dabei sollen vorzugsweise Substanzen aus der Gruppe der selektiven Serotoninwiederaufnahmehemmer (SSRI) zum Einsatz kommen. Bei der langfristigen ärztlichen Begleitung von ICD-Patienten sollen die psychosozialen Folgen der ICD-Technologie beachtet und insbesondere relevante Affektstörungen sowie Krisen bei ICD-Patienten erkannt und fachgerecht behandelt werden.
Schlussfolgerungen: Das Positionspapier formuliert konkrete Anwendungsfelder mit hoher Priorität für die Einbeziehung psychosozialer Faktoren in die kardiologische Praxis, die eine leitlinienkonforme Evidenz aufweisen. Trotz deutlicher Fortschritte seit der Erstveröffentlichung des Positionspapiers existieren weiterhin Forschungsdefizite für die Bewertung der Wirksamkeit psychotherapeutischer und psychopharmakologischer Konzepte bei kardialen Patienten. Curricula für die Vermittlung von (psycho-)diagnostischer, kommunikativer und differenzialdiagnostischer Kompetenz müssen rasch entwickelt werden, um eine Transmission des aktuellen Wissensstands in die Alltagspraxis zu ermöglichen.
GMS German Medical Science
10.3205/000194
24808816
urn:nbn:de:bvb:20-opus-121196
GMS Ger Med Sci. 2014;12:Doc09. DOI: 10.3205/000194, URN: urn:nbn:de:0183-0001945
Karl-Heinz Ladwig
Florian Lederbogen
Christian Albus
Christiane Angermann
Martin Borggrefe
Denise Fischer
Kurt Fritzsche
Markus Haass
Jochen Jordan
Jana Jünger
Ingrid Kindermann
Volker Köllner
Bernhard Kuhn
Martin Scherer
Melchior Seyfarth
Heinz Völler
Christiane Waller
Christoph Herrmann-Lingen
eng
uncontrolled
depression
eng
uncontrolled
anxiety
eng
uncontrolled
post-traumatic stress disorder
eng
uncontrolled
psychotherapy
eng
uncontrolled
psychopharmacology
deu
uncontrolled
Depression
deu
uncontrolled
Psychopharmakologie
deu
uncontrolled
Psychotherapie
deu
uncontrolled
posttraumatische Belastungsstörung
deu
uncontrolled
Angst
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/12119/028_Ladwig_GMS_German_Medical_Science.pdf
14993
2015
eng
e000182
2
article
1
2017-06-06
--
--
Natriuretic peptides for the detection of paroxysmal atrial fibrillation
Background and purpose:
Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study.
Methods:
Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF.
Results:
244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3–141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively.
Conclusions:
NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.
Open Heart
10.1136/openhrt-2014-000182
PMC4533200
urn:nbn:de:bvb:20-opus-149939
Open Heart 2015;2:e000182. DOI: 10.1136/openhrt-2014-000182
CC BY-NC: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell 4.0 International
Joachim Seegers
Markus Zabel
Timo Grüter
Antje Ammermann
Mark Weber-Krüger
Frank Edelmann
Götz Gelbrich
Lutz Binder
Christoph Herrmann-Lingen
Klaus Gröschel
Gerd Hasenfuß
Nicolas Feltgen
Burkert Pieske
Rolf Wachter
eng
uncontrolled
paroxysmal atrial fibrillation
eng
uncontrolled
ischaemic stroke
eng
uncontrolled
natriuretic peptide levels
Medizin und Gesundheit
open_access
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/14993/107_Seegers_Open_Heart.pdf
17244
2017
eng
18
article
1
2018-11-21
--
--
General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study
Background
Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs’ awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients.
Methods
For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients’ comorbidities and potential depression treatment. Descriptive and regression analysis were performed.
Results
GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient’s HRQOL was not significantly associated with the GPs' awareness of depression.
Conclusion
GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs’ awareness of depressive symptomatology is not linked to patients’ HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
BMC Family Practice
10.1186/s12875-017-0670-9
29221442
urn:nbn:de:bvb:20-opus-172445
BMC Family Practice (2017) 18:100. https://doi.org/10.1186/s12875-017-0670-9
true
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Marion Eisele
Sigrid Boczor
Anja Rakebrandt
Eva Blozik
Jens-Martin Trader
Stefan Stork
Christoph Herrmann-Lingen
Martin Scherer
eng
uncontrolled
Medicine
eng
uncontrolled
Depression
eng
uncontrolled
Heart failure
eng
uncontrolled
Recognition of depression
eng
uncontrolled
Quality of life
eng
uncontrolled
Depression treatment
eng
uncontrolled
Observational study
eng
uncontrolled
Primary care
eng
uncontrolled
Healthcare research
eng
uncontrolled
Depressive symptomatology
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/17244/Eisele_s12875-017-0670-9.pdf
24264
2021
eng
14
10
article
1
--
2021-07-12
--
Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
Journal of Clinical Medicine
2077-0383
10.3390/jcm10143071
urn:nbn:de:bvb:20-opus-242645
2021-08-01T14:07:33+00:00
sword
swordwue
attachment; filename=deposit.zip
58e5a382693c4745836c8a5918947a65
Journal of Clinical Medicine (2021) 10:14, 3071. https://doi.org/10.3390/jcm10143071
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Bernhard Schwaab
Birna Bjarnason-Wehrens
Karin Meng
Christian Albus
Annett Salzwedel
Jean-Paul Schmid
Werner Benzer
Matthes Metz
Katrin Jensen
Bernhard Rauch
Gerd Bönner
Patrick Brzoska
Heike Buhr-Schinner
Albrecht Charrier
Carsten Cordes
Gesine Dörr
Sarah Eichler
Anne-Kathrin Exner
Bernd Fromm
Stephan Gielen
Johannes Glatz
Helmut Gohlke
Maurizio Grilli
Detlef Gysan
Ursula Härtel
Harry Hahmann
Christoph Herrmann-Lingen
Gabriele Karger
Marthin Karoff
Ulrich Kiwus
Ernst Knoglinger
Christian-Wolfgang Krusch
Eike Langheim
Johannes Mann
Regina Max
Maria-Inti Metzendorf
Roland Nebel
Josef Niebauer
Hans-Georg Predel
Axel Preßler
Oliver Razum
Nils Reiss
Daniel Saure
Clemens von Schacky
Morten Schütt
Konrad Schultz
Eva-Maria Skoda
Diethard Steube
Marco Streibelt
Martin Stüttgen
Michaela Stüttgen
Martin Teufel
Hansueli Tschanz
Heinz Völler
Heiner Vogel
Ronja Westphal
eng
uncontrolled
cardiac rehabilitation
eng
uncontrolled
scientific guidelines
eng
uncontrolled
secondary prevention
eng
uncontrolled
physical activity
eng
uncontrolled
exercise training
eng
uncontrolled
psychological interventions
eng
uncontrolled
education
eng
uncontrolled
gender
eng
uncontrolled
frailty
eng
uncontrolled
migration
eng
uncontrolled
old patients
eng
uncontrolled
young patients
eng
uncontrolled
tele-medicine
eng
uncontrolled
home-based-rehabilitation
Medizin und Gesundheit
open_access
Institut für Psychotherapie und Medizinische Psychologie
Institut für Klinische Epidemiologie und Biometrie
Import
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/24264/jcm-10-03071.pdf