Search

Copyright of Herzschrittmachertherapie und Elektrophysiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Few studies have demonstrated the cost burden of cardiovascular events (CVEs) among patients with hyperlipidemia. The primary objective of this study was to determine the mean costs associated with CVEs among patients with hyperlipidemia by follow-up time period. Secondary objectives of this study included characterizing costs by CVE type and coronary heart disease (CHD) risk.Methods: This retrospective cohort study used longitudinal claims to calculate payer costs according to CHD risk level and type of CVE, during several follow-up periods (acute and short-term, comprising year 1; plus years 2 and 3).Results: There were 193,385 patients with hyperlipidemia with a CVE. Costs in the acute (30-day) period were highest ($22,404) driven by inpatient care (77%). Costs remained high ($15,133 in year 3) with ambulatory care (from 14% in acute to 37% in year 3) and pharmaceutical costs (from 2% in acute to 24% in year 3) representing a greater proportion. After second and third CVEs, acute costs were lower than for the first CVE. But in the post-acute periods, costs were higher after second and third CVEs than after first CVEs. Acute costs varied considerably by type of CVE ($9149 for transient ischemic attack to $54,251 for coronary artery bypass graft; P < 0.001), but post-acute costs were more similar across types. Costs differed by baseline CHD risk for all follow-up periods (P < 0.001), but less than by CVE type. As expected, patients without CVEs had significantly lower costs.Conclusion: Among patients with hyperlipidemia, the economic burden of CVEs is substantial up to 3 years after a CVE. Costs remain high after subsequent CVEs and actually increase for non-inpatient utilization.Funding: Amgen Inc. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular diseases represent a central challenge for our health care system because of their individual and societal consequences. The manuscript compares the current development of mortality and morbidity of coronary heart disease and stroke in Germany. Results: Coronary heart diseases are one of the leading causes of death and one of the major causes for adult disability. In Germany the average life expectancy has increased by more then 2 years per decade within recent years. The greatest contribution to the increase in life expectancy between 1980 and 2002 in Germany was attributed in previous studies to the decline in mortality rates of cardiovascular diseases; for example in Germany 134,648 persons died in 2008 from coronary heart disease (ICD-10 I20-I25) and 63,060 persons from stroke (ICD-10 I60-I64) compared to 178,759 persons and 90,241 persons in 1998, respectively. Statistical models from other countries estimated that the decrease in coronary heart disease mortality is attributed by about 40% to better treatment and by about 60% to changes in risk factors in the population. Comparable data for stroke are lacking. Conclusion: Despite the substantial knowledge on cardiovascular diseases in Germany a continuous and timely documentation of their determinants, time trends of risk factors and impact regarding mortality and morbidity is compulsory to assess the effectiveness of initiated population health measures and to identify future options for improving prevention and treatment of cardiovascular diseases in Germany. [ABSTRACT FROM AUTHOR]

Impairment of the release of endothelium and platelet derived-nitric oxide (NO) increases thrombus formation that is rich in platelets in non-ST elevation acute coronary syndromes (NSTE-ACS). Since intracoronary thrombus formation and distal embolization increases risk of myocardial injury, we studied the relationship between NO levels and Tn-I in patients with NSTE-ACS. Nitric oxide and Tn-I levels of 234 consecutive patients with NSTE-ACS were measured from venous samples at admission. The 137 patients whose Tn-I levels were below 0.20 ng/ml grouped as Tn-I negative and 97 patients whose Tn-I levels were equal to and above 0.21 ng/ml were grouped as Tn-I positive. Presence of visible thrombus, degree of flow in Thrombolysis in Myocardial Infarction (TIMI), and morphology of the lesion were evaluated with coronary angiographies. Presence of coronary thrombus, impaired TIMI flow, frequency of complex lesions, angina and ST-T changes were more frequent and associated with Tn-I levels in Tn-I positive patients. NO levels were lower in patients who were Tn-I positive, had angina and ST-T changes. NO levels were similar between patients with simple or complex lesions, but lower in patients who had coronary thrombus or TIMI flow grade <2. There was a negative correlation between levels of Tn-I and NO ( r = −0.87, P < 0.001). Logistic regression analysis revealed that NO levels were independent predictors in the differentiation of Tn-I negatives and positives ( r = 0.527, P < 0.001). This study revealed that NO levels are associated with myocardial injury in patients with NSTE-ACS. [ABSTRACT FROM AUTHOR]

Purpose: Microdialysis allows the biochemical analysis of interstitial fluids of nearly every organ as a bedside procedure. This technique could be useful to reveal data about the myocardial metabolism during cardiopulmonary bypass in human coronary artery bypass graft (CABG) surgery.Methods: In 17 patients undergoing CABG a myocardial microdialysis catheter (CMA 70, CMA/Microdialysis AB, Sweden) was inserted in the apical region of the beating heart. Microdialysis measurements were performed at timed intervals before, during, and after cardiopulmonary bypass (CPB). The concentrations of lactate and pyruvate were analyzed semi-continuously.Results: During CPB the myocardial lactate-pyruvate-ratio (LPR) rose from an initial 11 (8-15) to 33 (29-41) ( P<0.01). After CPB the LPR decreased to 4 (3-7) at the end of observation ( P<0.05). The pyruvate concentration showed an immediate increase from 34 (30-42) microM at the end of CPB to 181 (147-234) microM after removal of the cross-clamp with subsequent increase during reperfusion ( P<0.01). Plasma lactate and pyruvate showed no essential changes during the study.Conclusion: Using the microdialysis technique it was possible to analyze myocardial metabolic changes during CABG. The course of myocardial LPR as a sensitive indicator of the myocardial redox state showed profound changes during and after CPB. We propose the microdialysis technique as an additional monitoring tool in CABG. [ABSTRACT FROM AUTHOR]