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The article profiles former physician George Wolff, who was born on April 9, 1886 in Germany and died in Washington, D.C. on September 16, 1952. A discussion of Wolff's research on medical topics and social medicine, and of his relationship with his mentor, academician and social medicine advocate Alfred Grotjahn, is presented.

Gastroesophageal reflux disease can be divided into three categories: nonerosive GERD (NERD), erosive GERD (ERD), and Barrett's esophagus. A shift among these categories rarely occurs. The aim of the present study was to elucidate potential patient-associated risk factors associated with ERD.A total of 6,215 patients with troublesome heartburn were recruited to a large, prospective, multicenter open cohort study comprising an initial treatment phase and a 5-yr follow-up phase. Each center planned to recruit an equal number of patients with NERD and ERD. All patients underwent an interview based on standardized questionnaires, a physical examination, and endoscopy with biopsies. Data were analyzed by multiple logistic regression analysis.Risk factor analysis was performed on 5,289 patients (NERD: n = 2,834; ERD: n = 2,455), which was the intent-to-treat population excluding patients with suspected/proven complicated reflux disease. Stepwise regression analysis identified the following independent predictors of ERD: male gender, overweight, regular use of alcohol, a history of GERD1 yr, and smoker or ex-smoker. A higher level of education and a positive Helicobacter pylori (H. pylori) status were associated with a lower risk of ERD.Some patient-associated factors increase the risk of erosive esophagitis as opposed to nonerosive reflux disease. However, no single factor or combination of factors is capable of predicting mucosal damage with clinically sufficient certainty. Thus, endoscopy is still required in all GERD patients if valid information on the state of the esophageal mucosa is needed.

The aim of the present study was to assess change in health-related quality of life (HRQoL) after cardiac rehabilitation in the usual care setting, and to determine predictors for change. In the Post Infarction Care Study, 2441 patients were consecutively included at admission to 18 inpatient cardiac rehabilitation centres following coronary events. HRQoL was assessed with the SF-36 questionnaire at baseline as well as 6 and 12 months after discharge. HRQoL improved significantly in patients after coronary artery bypass grafting (CABG) but not in patients after myocardial infarction. Significant baseline predictors for change of the SF-36 physical component summary (PCS) score were the exercise ECG result at admission (0.59 absolute change/10-watt increase; 95% CI: 0.39, 0.79), an incomeor = 1750 euros (1.64; 95% CI: 0.35, 2.93), baseline PCS score (-0.63; 95% CI: -0.69, -0.57), and CABG as indication for admission (3.65; 95% CI: 2.27, 5.04). Significant predictors for change of the mental component summary (MCS) score were age (1.28/10-year increase; 95% CI: 0.62, 1.94), East Germany as area of residence (2.62; 95% CI: 1.32, 3.91), baseline MCS score (-0.58; 95% CI: -0.63, -0.52), and CABG as indication for admission (1.68; 95% CI: 0.36, 3.01). The identification of predictors of HRQoL in the present study may aid in the further development and evaluation of cardiac rehabilitation programmes.

Primary prevention is a major option to reduce the burden of chronic disease in populations. Because lifestyle interventions have proved to be effective, lifestyle recommendations including nutritional advice are made abundantly. However, both their credibility and their effectiveness are often considered not to be high. Therefore, scientific evidence should form the basis of recommendations and, as in clinical medicine, a rational approach should be followed for the evaluation of evidence. In this paper, the development and current concepts of ‘levels of evidence’ as they are applied in clinical medicine are outlined and their impact on evidence-based recommendations is discussed. Next, the question is raised as to how far the existing schemes are applicable to the evaluation of issues pertaining to primary prevention through lifestyle changes. Current schemes were developed mainly for clinical research questions and therefore place major emphasis on randomised controlled trials as the main and most convincing evidence in the evaluation process. These types of study are rarely available for lifestyle-related factors and might even not be feasible to obtain. Arguments are advanced to support the notion that a modification of currently existing ‘levels of evidence’ as developed for clinical research questions might be necessary. Thereby, one might be able to accommodate the specific aspects of evidence-related issues of recommendations for primary prevention through lifestyle changes, like dietary changes.

A limiting factor for immediate initiation of stroke therapy is delayed hospital arrival. We assessed general knowledge on and behavior during an acute stroke with particular emphasis on prehospital temporal delays and a focus on the high-risk group of patients with atrial fibrillation (AF).As part of the Berlin Acute Stroke Study (BASS), we interviewed patients admitted to hospital with symptoms of stroke using a standardized questionnaire. Cardiac rhythm was assessed by ECG and Holter monitor. Data analysis included additional stratification for age and gender.Of a total of 558 patients (66.8 +/- 13.5 years; 45% female) diagnosed with TIA or stroke 28% interpreted their own symptoms correctly as due to stroke. Female patients reporting cardiac arrhythmias and having AF more often correctly interpreted their symptoms as stroke (P = 0.03), considered their symptoms urgent (P = 0.02), considered stroke a medical emergency (P0.05) and had shorter prehospital delay times (P = 0.001) compared to female patients not reporting cardiac arrhythmias. Male, younger (65 years) and older patient groups showed no such effect, respectively.Females who know to have AF demonstrate better knowledge of stroke symptoms compared to females unaware or without this risk factor. This better knowledge translates into more appropriate behavior during an acute stroke.

Objective Disease severity is considered an important risk factor for malnutrition in hospitalized patients. We investigated the effect of social factors and disease parameters on the development of malnutrition. Methods Nutritional state was assessed by the Subjective Global Assessment in 794 consecutively admitted patients in two hospitals in Berlin (n = 493, university hospital; n = 301, district hospital). The influences of age, sex, social status, life habits, and disease parameters on nutritional state was analyzed with univariate and multivariate logistic regression methods. Results Malnutrition was diagnosed in 22% of patients. Its prevalence was significantly higher in patients with malignant than with benign diseases (odds ratio [OR] = 1.568, P < 0.05) and in patients with multiple prescriptions (OR = 1.154, P < 0.001), but no difference was found between medical or surgical patients. The strongest risk factors for malnutrition in univariate analysis were age older than 60 y (OR = 2.861, P < 0.001), living alone (OR = 1.769, P = 0.002), and achieving a lower level of education (OR = 1.589, P < 0.05). Therefore, multivariate analysis was performed after stratification for age. Demonstrated independent additional risk factors were polypharmacy (OR = 2.367, P < 0.001) and malignant disease (OR = 4.114, P < 0.001) in young patients and polypharmacy (OR = 1.109, P < 0.002) and living alone (OR = 1.830, P = 0.008) in patients 60 y and older. Conclusions These data show that patients who are older, less educated, and live alone are at high risk of developing malnutrition. Thus special attention should be given to these risk groups when evaluating nutritional status and nutritional support.

The objectives of the present study were to determine prospectively return to work and its predictors in patients after cardiac rehabilitation.Patients were enrolled at admission to inpatient cardiac rehabilitation centres (n = 18). Primary indications for admission were myocardial infarction, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty.We included 2441 consecutive patients (1907 men, mean age: 60 +/- 10 years; 534 women, mean age: 65 +/- 10 years). A total of 43% of all patients had been actively employed before the event. Of these patients, 65% had returned to work six months and 67% 12 months after cardiac rehabilitation. Successful return to work after 12 months was significantly predicted by younger age, non-manual work, self-employment, a higher physical and mental quality of life, and a better exercise ECG result.Return to work is predicted by sociodemographic factors, quality of life, and the exercise ECG at the rehabilitation centre. The determination of early predictors for return to work may aid to identify patients particularly at risk for failure to return to work.

Aspects of care such as efficacy, effectiveness and efficiency have to be taken into account prior to the implementation of any new antihypertensive medication into routine medical care. The efficacy of angiotensin (AT) II antagonists in lowering blood pressure was summarized in a metaanalysis including 43 trials and a total of 11,281 patients. The four AT II antagonist classes losartan, valsartan, irbesartan, and candesartan were studied and achieved a mean reduction in systolic blood pressure between 10.4 und 11.8 mmHg and in diastolic blood pressure between 8.2 und 8.9 mmHg. The effectiveness of AT II antagonist therapy in reducing clinical events such as stroke or end-stage renal disease in hypertension and associated conditions was shown in a number of large trials. Also, less adverse events were reported for AT II antagonist therapy compared to other antihypertensive medication such as beta blockers and angiotensin-converting enzyme (ACE) inhibitors. However, the number of trials is still comparatively small. Several ongoing trials will provide further insight into the effectiveness of AT II antagonist therapy. The efficiency of AT II antagonist therapy in being a cost-effective alternative for reducing clinical events in patients with hypertension requires further research. The combination of data from clinical trials with epidemiologic data about the natural history of the disease and factors such as patient compliance, side effects, acquisition costs or medication switch is needed to reflect costs in the “real-world” situation.

Previous reports of a circadian variation of angina pectoris were based primarily on selected patients of clinical studies. The present ESCVA Study (European Survey on Circadian Variation of Angina Pectoris) was designed to determine the timing of angina pectoris attacks in outpatients, the association of wake time and possible external triggers with angina attacks, and the influence of cardiac medication on the circadian pattern. Inclusion criteria were stable angina pectoris for at least 3 months, average frequency of two or more attacks per week, and treatment with on-demand nitrates. Standardized self-administered questionnaires were provided to all participating physicians to obtain medical information and to their patients to obtain prospective recordings of angina attacks during the 7 subsequent days. From January 1998 to March 1999, 1,333 patients (60% male, 65 ± 10 years, 40% female, 68 ± 10 years) were enrolled in 243 centers of six European countries and reported a total of 4,293 angina pectoris attacks (range 0–48 per patient). The occurrence of angina pectoris demonstrated a significant circadian variation (p < 0.001) with a primary morning peak from 09:00 to 12:00 o’clock (relative risk 2.9, 95% confidence interval 2.6–3.2, compared to other times of day) and a secondary afternoon peak from 15:00 to 18:00 o’clock (relative risk 1.5, 95% confidence interval 1.3–1.7). Of all angina attacks 50% occurred within the initial 6 h after awakening, and 74% were associated with possible external triggers such as physical activity or anger. The study demonstrated a marked wake time-related circadian variation in the occurrence of angina pectoris attacks. To improve preventive strategies, type, dosage and particularly timing of cardiac medication appear of importance, as may be behavior modification.

Systematic reviews are considered the most reliable tool to summarize existing evidence. To determine whether reviews that address the same questions can produce different answers we examined systematic reviews of herbal medicine, homeopathy, and acupuncture taken from a previously established database. Information on literature searching, inclusion criteria, selection process, quality assessment, data extraction, methods to summarize primary studies, number of included studies, results and conclusions was compared qualitatively. Seventeen topics (eight on acupuncture, six on herbal medicines, three on homeopathy) had been addressed by 2–5 systematic reviews each. The number of primary studies in the reviews varied greatly within most topics. The most obvious reason for discrepancies between the samples was different inclusion criteria (in thirteen topics). Methods of literature searching may have contributed with some topics but the equivalence of the searches was difficult to assess. Differences were frequently observed in other methodological aspects, in results and in conclusions. This analysis shows that, at least in the three areas examined, systematic reviews often differ considerably. Readers should be aware that apparently minor decisions in the review process can have major impact.

Evidence-based medicine (EBM) is considered complicated and its realization in everyday medical practice causes difficulties. Therefore, in the course of the present study we made each physician of a university hospital the offer that we would undertake for them a systematic search for and critical assessment of the medical literature on a particular patient-related question they might have. One to two weeks after we had supplied our answers, the influence our answers had had on the medical decisions taken and the overall satisfaction with our offer were evaluated using standardized questionnaires.A total of 34 EBM questions were asked, 31 (91%) of which had a shape that permitted an answer to be obtained. The median time required for supplying an answer was 7 hours (within a range of 3 to 32). In the course of the subsequent evaluation process it was possible to analyze 19 questionnaires (the equivalent of a response rate of 61%). In general our EBM answers were considered good, comprehensible and transparent. For 2/3 of the participants the answers supplied by us satisfied their informational requirements and could be applied satisfactorily in clinical practice.The offer of external high-quality search-and-assessment of medical literature is useful, but the process is time consuming. Easier access to medical information and knowledge of how to search for and assess literature are important preconditions for the successful implementation of EBM. To achieve the latter evidence-based secondary literature and the development of evidence-based guidelines appear to be reasonable alternatives.

Background and Purpose: After the unification in 1990 two different health and political systems merged in Germany. Our aim was to analyze trends in mortality from cerebrovascular diseases in the formerly divided western and eastern parts of Germany since the unification. Methods: Trends in mortality were determined by analyzing age-adjusted vital statistics data obtained from the Federal Statistics Office. ICD-9 was used from 1990 to 1997 and ICD-10 in 1998 and 1999. Results: Cerebrovascular mortality declined in Germany between 1991 and 1999 from 104.4 to 72.3 per 100,000 men and from 82.2 to 55.5 per 100,000 women. Mortality rates from cerebrovascular diseases in East Germany were continuously above West German rates: in 1991 the overall rate ratio in East compared to West Germany was 1.6 and in 1999 it was 1.5 in both men and women. This regional variation is mainly due to a higher rate of cerebrovascular diseases being defined as ‘Other’ (ICD-9 437, now ICD-10 I67) in East compared to West Germany. Conclusion: Nearly 10 years after the unification, cerebrovascular mortality is still markedly higher in East compared to the West Germany. Further investigation is needed to determine the causes for the regional variation in cerebrovascular mortality and to improve preventive strategies.

Der plotzliche Herztod ist weiterhin fur etwa die Halfte aller kardialen Todesfalle in den westlichen Industrienationen verantwortlich. In den USA ereignen sich ca. 225 000 Falle von plotzlichem Herztod pro Jahr. In Deutschland ergaben die Daten des MONICA/ KORA-Augsburg-Herzinfarktregisters 1995/97 eine Rate an plotzlichen Herztodfallen (

Introduction Apart from clinical events, health-related quality (HRQoL) is an important outcome in high-risk cardiovascular patients. As body mass index has been associated with clinical events (“obesity paradox”), we investigated the relationship between body mass index and health-related quality of life. Methods Patients were included with hypercholesterolaemia and an indication for statin therapy in 1961 primary care practices. HRQoL was assessed with the Short Form (SF)-12 health status instrument at baseline, after 6 and after 12 months. Physicians assessed patient body mass index (BMI). A mixed-effects regression model accounting for the three measurement points was used to investigate (a) the association between BMI and HRQoL at baseline, and (b) the association between change in BMI and change in HRQoL. Results A total of 5082 patients (2165 females) were included. The mean change in BMI within 12 months was 0.05 (SD: 1.11) kg/m2. At baseline, BMI was inversely associated with physical and mental SF-12 summary scores (β [95% CI]=−0.3 [−0.4 to −0.2], and −0.1[−0.1 to 0.0]). An increase in BMI of 1 kg/m2 within 12 months was associated with a significant decrease in physical but not mental SF-12 scores (0.3 [−0.4 to −0.1]). Due to an interaction with gender, the association between change in BMI and physical SF-12 scores was only prevalent in women (β=−0.5 [−0.7 to -0.2], p

The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR.A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Health care is a prominent focus of domestic policy in Germany as well as in the United States and other industrialized countries. The health care sector nowadays has in fact become a battlefield for lobbying players of the medical arena including patients, physicians, politicians, social scientists, and representatives of health insurance organizations, hospitals, pharmaceutical and other medical companies.

Medical challenges for the new Millennium , Medical challenges for the new Millennium , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Background The Brandenburg Asthma and Allergy Study (BASAL) is part of a larger survey initiated by the Global Allergy and Asthma European Network (GA2LEN). The aim of the GA2LEN Survey was to assess the prevalence of allergic diseases, especially in populations rarely examined for allergies.

Several studies have reported circadian and seasonal variations in acute cardiovascular disease. In addition, a weekly variation has been observed in acute myocardial infarction. The aim of our study was to determine the circadian weekly, and seasonal variations of sudden death utilizing population-based data.We analysed the emergency medical system data of Berlin (West) from 1987-1991 with respect to all consecutive sudden deaths in subjects18 years (n=24 061). There was a marked circadian variation of sudden death, with a minimum between 0 and 6 h and a maximum between 6 and 12 h (P0.0001) for every day of the week. A minimum of events occurred on Sundays (n=3143), and a maximum on Mondays (n=3721), corresponding to a relative increase of 18.3% (P0.0001). The increase was more pronounced (23.6%) in patientsor =65 than in patients65 (15.7%). In addition, we found a significant seasonal variation (P0.0001) in events, with a maximum during winter (December to February, n=6493), and a minimum during summer (June to August, n=5472), corresponding to a relative difference of 18.7%. The seasonal variation was more pronounced in patients65 years.The present analyses demonstrate marked variations in the occurrence of sudden death with peaks during morning hours, on Mondays, and during winter months. The findings suggest that the onset of sudden death may be associated with endogenous rhythms and external factors including climatic conditions.

Myokardinfarkte konnen durch externe Faktoren ausgelost werden. Dazu zahlen u.a. korperliche Aktivitat und emo- tionale Belastung; weitere, seltene Ausloser sind z.B. Bedrohungen von ausen durch Kriege oder Erdbeben. Veranderungen der Umwelt spielen fur die Inzidenz von Myokardinfarkten ebenso eine Rolle wie Tageszeit, Wochentag oder Jahreszeit. Das Verhalten der Patienten bei Einsetzen der Symptome in der Prahospitalphase hangt von verschiedenen Faktoren ab und beeinflust entscheidend den weiteren Verlauf und die Mortalitat. Geeignete praventive Masnahmen zum Schutz der Patienten wahrend Zeiten von erhohtem Risiko erscheinen, ebenso wie eine verstarkte Aufklarung uber das adaquate Verhalten und Rettungsersuchen bei Beginn von Symptomen, erforderlich.

To determine if sudden cardiac death shows a circadian variation, the mortality records of the Massachusetts population and the Framingham Heart Study were analyzed. The Massachusetts mortality data analysis revealed an increased morning incidence for out-of-hospital cardiac deaths similar to that previously described for nonfatal myocardial infarction. The records of the Framingham Heart Study allowed more comprehensive analysis of the time of sudden cardiac death. In this study, a prominent circadian variation was also identified in which frequency of sudden cardiac death increased sharply between 6 A.M. and 9 P.M.; distribution was fairly even throughout the rest of the day. This circadian pattern may be explained in part by physiologic changes that increase the likelihood of ventricular fibrillation or increase the risk of thrombosis in the morning hours. The possible role of the morning increase in physical and mental activity as a trigger of sudden cardiac death requires further investigation.

Objective To investigate the effectiveness of acupuncture in addition to routine care, compared with routine care alone, in the treatment of patients with chronic pain due to osteoarthritis (OA) of the knee or hip. Methods In a randomized, controlled trial, patients with chronic pain due to OA of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization underwent acupuncture treatment. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months. Results Of 3,633 patients, 357 were randomized to the acupuncture group and 355 to the control group and 2,921 were included in the nonrandomized acupuncture group. At 3 months, the WOMAC had improved by a mean ± SEM of 17.6 ±1.0 in the acupuncture group and 0.9 ± 1.0 in the control group (difference in improvement 16.7 ± 1.4; P Conclusion These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA–associated pain of the knee or hip.

The circadian, day-of-week, and seasonal distributions of acute myocardial infarction and its association with the patients' working status were analyzed in a regionally defined population (n = 103, 322) monitored from 1980 to 1988. Included were 2906 consecutive patients (1746 [60.1%] men and 1160 [39.9%] women; mean age 67.8 years) with confirmed diagnosis (by standardized diagnostic criteria in hospitalized patients and autopsy results in out-of-hospital deaths). The time of myocardial infarction on the basis of onset of symptoms was known in 1901 cases. Myocardial infarction occurred more frequently (p < 0.05) during the morning from 7:00 to 10:00 AM, on Mondays, and during the winter from January to March compared with other times of day, days of the week, and seasons. Compared with retired patients, working patients (32%) had a second circadian peak, in the afternoon at 4:00 PM (p < 0.05), and a trend toward an additional seasonal peak in September (p value not significant), whereas the day-of-week pattern was similar in the two subgroups. The occurrence of myocardial infarction demonstrates marked circadian, day-of-week, and seasonal variations, with some differences between working and retired patients. Further investigation of possible triggering events may aid in identifying underlaying mechanisms and perhaps in improving prevention of the disease.

Sudden cardiac death (SCD) is one of the most prominent disorders in Western industrialised societies, afflicting at least 300,000 individuals each year in the United States alone [1–3]. Recent analyses of several register sites of the MONICA (Monitoring of Trends and Determinants of Cardiovascular Disease) project of the World Health Organisation [4–6] demonstrate that approximately 25% of all patients with an acute coronary event die within the first hour after onset of the event (Figure 1). For these patients — victims of SCD — there is usually no adequate immediate medical treatment available. The MONICA project is a large international collaboration in over 20 countries to measure trends in cardiovascular mortality and to assess the extent to which these changes are related to changes in risk factors and medical care [4–6]. Since the study sites register all cardiac events within predefined populations, including hospitalized patients with myocardial infarction and prehospital cardiac deaths, this project allows assessment of the overall sequence of hospitalization and mortality (Figure 1).

Study of triggering of the acute coronary syndromes received great stimulus from the relatively simple observation that the disorders have a prominent circadian variation of onset. The widespread recognition of the morning increase of myocardial infarction [1] and sudden cardiac death [2] has convinced many that the activities of the morning “trigger” onset of a sizeable percentage of the events.

Approximately two thirds of all deaths due to acute myocardial infarction occur before patients are hospitalized [1–5]. The early phase of myocardial infarction therefore offers, from a case-fatality point of view, an enormous potential not only for ‘preventive’ but also for curative therapeutic approaches. Early competent intervention is possible in three strategies: 1. In the case of instantaneous cardiac death (which is primarily arrhythmia-related, in association with the onset of myocardial ischemia), there is a chance of successful cardiopulmonary resuscitation if the patient receives immediate medical attention. 2. Although medical attention and monitoring offers only limited possibilities for preventing malignant arrhythmia, it may provide optimal therapeutic benefit if availaible at the onset of life-threatening arrhythmias. 3. Finally, new therapeutic approaches for definitive treatment of myocardial infarction can be initiated or even fully administered, thus improving the patient’s medium-term and long-term prognosis.

To determine the circadian variation of sustained ventricular tachyarrhythmias, 78 consecutive patients with an implanted cardioverter defibrillator were analyzed with regard to the occurrence of spontaneous shock episodes during a mean follow-up period of 18 +/- 12 months. In 39 patients 207 shock episodes that terminated potentially life-threatening ventricular tachyarrhythmias could be related to an exact time of onset. A circadian variation (p0.001) of these events was demonstrated, with a primary morning peak between 7 hours and 11 hours and a secondary, much smaller peak between 16 hours and 20 hours. This finding indicates the relevance of endogeneous or exogeneous triggers in the cause of malignant arrhythmias that potentially lead to sudden cardiac death. Subgroup analyses revealed an association of the circadian pattern to the New York Heart Association functional classification, indicating perhaps a different role of triggers in different patient populations.

To investigate whether a shorter health status instrument, the short form (SF)-12, is comparable with its longer version, the SF-36, for measuring health related quality of life of patients with coronary heart disease.Prospective cohort study with follow up at six and 12 months.18 cardiac rehabilitation centres in Germany.Patients were enrolled at admission to the rehabilitation centres after myocardial infarction, coronary artery bypass grafting, and percutaneous transluminal coronary angioplasty.Correlation coefficients were calculated between SF-12 and SF-36 physical component summary (PCS-12/-36) and mental component summary (MCS-12/-36) scores and the respective change scores. Responsiveness to change was determined with the standardised response mean.2441 patients were enrolled (78% men, mean (SD) age 60 (10) years; 22% women, 65 (10) years). Baseline PCS-12 and PCS-36 scores were highly correlated (r = 0.96, p0.001), as were baseline MCS-12 and MCS-36 scores (r = 0.96, p0.001). Similarly, change scores between baseline and 12 months were highly correlated (PCS-12/-36: r = 0.94, p0.001; MCS-12/-36: r = 0.95, p0.001). There was no difference in standardised response means between the SF-12 and SF-36 scales.The SF-12 summary measures replicate well the SF-36 summary measures and show similar responsiveness to change. The SF-12 appears to be an efficient alternative to the SF-36 for the assessment of health related quality of life of patients with coronary heart disease.