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1. Association of BMI, lipid-lowering medication, and age with prevalence of type 2 diabetes in adults with heterozygous familial hypercholesterolaemia: a worldwide cross-sectional study

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Elshorbagy, Amany, Lyons, Alexander R.M., Vallejo-Vaz, Antonio J., Stevens, Christophe A.T., Dharmayat, Kanika I., Brandts, Julia, Catapano, Alberico L., Freiberger, Tomas, Hovingh, G. Kees, Mata, Pedro, Raal, Frederick J., Santos, Raul D., Soran, Handrean, Watts, Gerald F., Abifadel, Marianne, Aguilar-Salinas, Carlos A., Alhabib, Khalid F., Alkhnifsawi, Mutaz, Almahmeed, Wael, Alonso, Rodrigo, Al-Rasadi, Khalid, Al-Sarraf, Ahmad, Ashavaid, Tester F., Banach, Maciej, Binder, Christoph J., Bourbon, Mafalda, Brunham, Liam R., Chlebus, Krzysztof, Corral, Pablo, Cruz, Diogo, Davletov, Kairat, Descamps, Olivier S., Ezhov, Marat, Gaita, Dan, Groselj, Urh, Harada-Shiba, Mariko, Holven, Kirsten B., Kayikcioglu, Meral, Khovidhunkit, Weerapan, Lalic, Katarina, Latkovskis, Gustavs, Laufs, Ulrich, Liberopoulos, Evangelos, Lima-Martinez, Marcos M., Lin, Jie, Maher, Vincent, Marais, A. David, März, Winfried, Mirrakhimov, Erkin, Miserez, André R., Mitchenko, Olena, Nawawi, Hapizah, Nordestgaard, Børge G., Panayiotou, Andrie G., Paragh, György, Petrulioniene, Zaneta, Pojskic, Belma, Postadzhiyan, Arman, Reda, Ashraf, Reiner, Željko, Reyes, Ximena, Sadiq, Fouzia, Sadoh, Wilson E., Schunkert, Heribert, Shek, Aleksandr B., Stroes, Erik, Su, Ta-Chen, Subramaniam, Tavintharan, Susekov, Andrey V., Tilney, Myra, Tomlinson, Brian, Truong, Thanh-Huong, Tselepis, Alexandros D., Tybjærg-Hansen, Anne, Vázquez, Alejandra C., Viigimaa, Margus, Vohnout, Branislav, Wang, Luya, Yamashita, Shizuya, Arca, Marcello, Averna, Maurizio, Schreier, Laura, Pang, Jing, Ebenbichler, Christoph, Dieplinger, Hans, Innerhofer, Reinhold, Winhofer-Stöckl, Yvonne, Greber-Platzer, Susanne, Krychtiuk, Konstantin, Speidl, Walter, Toplak, Hermann, Widhalm, Kurt, Stulnig, Thomas, Huber, Kurt, Höllerl, Florian, Rega-Kaun, Gersina, Kleemann, Lucas, Mäser, Martin, Scholl-Bürgi, Sabine, Säly, Christoph, Mayer, Florian J., Sperone, Alexandra, Tanghe, Chloé, Gérard, Anne-Catherine, Pojskic, Lamija, Sisic, Ibrahim, Durak Nalbantic, Azra, Ejubovic, Malik, Jannes, Cinthia E., Pereira, Alexandre C., Krieger, Jose E., Petrov, Ivo, Goudev, Assen, Nikolov, Fedya, Tisheva, Snejana, Yotov, Yoto, Tzvetkov, Ivajlo, Baass, Alexis, Bergeron, Jean, Bernard, Sophie, Brisson, Diane, Cermakova, Lubomira, Couture, Patrick, Francis, Gordon A., Gaudet, Daniel, Hegele, Robert A., Khoury, Etienne, Mancini, G.B. John, McCrindle, Brian W., Paquette, Martine, Ruel, Isabelle, Iatan, Iulia, Cuevas, Ada, Wang, Xumin, Meng, Kang, Song, Xiantao, Yong, Qiang, Jiang, Tao, Liu, Ziyou, Duan, Yanyu, Hong, Jing, Ye, Pucong, Chen, Yan, Qi, Jianguang, Liu, Zesen, Li, Yuntao, Zhang, Chaoyi, Peng, Jie, Yang, Ya, Yu, Wei, Wang, Qian, Yuan, Hui, Cheng, Shitong, Jiang, Long, Chong, Mei, Jiao, Jian, Wu, Yue, Wen, Wenhui, Xu, Liyuan, Zhang, Ruiying, Qu, Yichen, He, Jianxun, Fan, Xuesong, Wang, Zhenjia, Chow, Elaine, Pećin, Ivan, Perica, Dražen, Symeonides, Phivos, Vrablik, Michal, Ceska, Richard, Soska, Vladimir, Tichy, Lukas, Adamkova, Vera, Franekova, Jana, Cifkova, Renata, Kraml, Pavel, Vonaskova, Katerina, Cepova, Jana, Dusejovska, Magdalena, Pavlickova, Lenka, Blaha, Vladimir, Rosolova, Hana, Nussbaumerova, Barbora, Cibulka, Roman, Vaverkova, Helena, Cibickova, Lubica, Krejsova, Zdenka, Rehouskova, Katerina, Malina, Pavel, Budikova, Milena, Palanova, Vaclava, Solcova, Lucie, Lubasova, Alena, Podzimkova, Helena, Bujdak, Juraj, Vesely, Jiri, Jordanova, Marta, Salek, Tomas, Urbanek, Robin, Zemek, Stanislav, Lacko, Jan, Halamkova, Hana, Machacova, Sona, Mala, Sarka, Cubova, Eva, Valoskova, Katerina, Burda, Lukas, Benn, Marianne, Bendary, Ahmed, Daoud, Ihab, Emil, Sameh, Elbahry, Atef, Rafla, Samir, Sanad, Osama, Kazamel, Ghada, Ashraf, Dr Mohamed, Sobhy, Mohamed, El-Hadidy, Amro, Shafy, Mohamed Abdoul, Kamal, Saif, Bendary, Mohamed, Talviste, Grete, Christmann, Jutta, Dressel, Alexander, Fath, Felix, Ferraro, Chiara, Frenzke, Lydia, Gopon, Alica, Klein, Isabel, Pienkowska, Dominika, Sietmann, Tobias, Sonntag, Antonia, Adjan, Omar, Bahrmann, Philipp, Baessler, Andrea, Barkowski, Rasmus, Beckerdjian, Raffi, Berr, Christina, Birkenfeld, Andreas, Böll, Gereon, Carstensen, Avisha, Demuth, Ilya, Finkernagel, Holger, Gouni-Berthold, Ioanna, Hahmann, Harry, Hamerle, Michael, Halder, Julian, Heide, Maria, Julius, Ulrich, Kassner, Ursula, Katzmann, Julius L, Kirschbaum, Anja, Klose, Gerald, Könemann, Stephanie, König, Christel, König, Wolfgang, Krämer, Bernhard, Kuprat, Gerrit, Koschker, Ann-Cathrin, Kilic, Özlem, Lindenmeier, Gerd, Van de Loo, Iris, Lorenz, Babette, Lorenz, Elke, Löhr, Birgit, McChord, Johanna, Maslarska, Mariya, Methe, Heiko, Merkel, Martin, Moussaoui, Zineb, Müller-Kozarez, Irina, Olivier, Christoph B, Ong, Peter, Otte, Britta, Parhofer, Klaus, Partsch, Carl-Joachim, Paulus, Michael, Pehlivanli, Sinan, Pflederer, Tobias, Pusl, Thomas, Richter, Veronika, Rosner, Stefanie, Sanin, Veronika, Schäfer, Sebastian, Schäfer, Christoph, Schatz, Ulrike, Schirmer, Stephan, Schmidt, Christine, Seeger, Wolfgang, Sisovic, Snezna, Spens, Antje, Jablonski, Ksenija Stach, Stadelmann, Alexander, Steinhagen-Thiessen, Elisabeth, Stürzebecher, Paulina, Tafelmeier, Maria, Tillack, Dörthe, Tselmin, Sergey, Tünnemann-Tarr, Adrienn, Vogt, Anja, Beckerath, Jens von, Wilke, Andreas, Wolf, Ulrich, Zemmrich, Claudia, Rizos, Christos V., Skoumas, Ioannis, Tziomalos, Konstantinos, Rallidis, Loukianos, Kotsis, Vasileios, Doumas, Michalis, Athyros, Vasileios, Skalidis, Emmanouil, Kolovou, Genovefa, Kolovou, Vana, Garoufi, Anastasia, Bilianou, Eleni, Koutagiar, Iosif, Kiouri, Estela, Antza, Christina, Zacharis, Evangelos, Attilakos, Achilleas, Sfikas, George, Koumaras, Charalambos, Anagnostis, Panagiotis, Anastasiou, Georgia, Liamis, George, Koutsogianni, Amalia-Despoina, Petkou, Ermioni, Milionis, Haralambos, Koulouri, Anastasia, Prodromiadou, Elisavet, Karányi, Zsolt, Harangi, Mariann, Bajnok, László, Audikovszky, Mária, Márk, László, Benczúr, Béla, Reiber, István, Nagy, Gergely, Nagy, András, Reddy, Lakshmi Lavanya, Shah, Swarup A. V, Ponde, Chandrashekhar K., Dalal, Jamshed J., Sawhney, Jitendra P.S., Verma, Ishwar C., Altaey, Mays, Al-Jumaily, Khalid, Rasul, Dilshad, Abdalsahib, Ali Fawzi, Jabbar, Amer Abdl, Al-ageedi, Mohanad, Dhamin, Mohammed, AlFil, Sarmad, Khadhim, Foad, Miahy, Sabah, Agar, Ruth, Catapano, Alberico Luigi, Calandra, Sebastiano, Tarugi, Patrizia, Casula, Manuela, Galimberti, Federica, Olmastroni, Elena, Sarzani, Riccardo, Ferri, Claudio, Repetti, Elena, Piro, Salvatore, Suppressa, Patrizia, Meregalli, Giancarla, Borghi, Claudio, Muntoni, Sandro, Calabrò, Paolo, Cipollone, Francesco, Purrello, Francesco, Pujia, Arturo, Passaro, Angelina, Marcucci, Rossella, Pecchioli, Valerio, Pisciotta, Livia, Mandraffino, Giuseppe, Pellegatta, Fabio, Mombelli, Giuliana, Branchi, Adriana, Fiorenza, Anna Maria, Pederiva, Cristina, Werba, Josè Pablo, Parati, Gianfranco, Carubbi, Francesca, Iughetti, Lorenzo, Fortunato, Giuliana, Iannuzzi, Arcangelo, Iannuzzo, Gabriella, Cefalù, Angelo Baldassare, Biasucci, Giacomo, Zambon, Sabina, Pirro, Matteo, Sbrana, Francesco, Trenti, Chiara, D'Erasmo, Laura, Federici, Massimo, Ben, Maria Del, Bartuli, Andrea, Giaccari, Andrea, Pipolo, Antonio, Citroni, Nadia, Guardamagna, Ornella, Lia, Salvatore, Benso, Andrea, Biolo, Gianni, Maroni, Lorenzo, Lupi, Alessandro, Bonanni, Luca, Rinaldi, Elisabetta, Zenti, Maria Grazia, Matsuki, Kota, Hori, Mika, Ogura, Masatsune, Masuda, Daisaku, Kobayashi, Takuya, Nagahama, Kumiko, Al-Jarallah, Mohammed, Radovic, Mirjana, Lunegova, Olga, Bektasheva, Erkayim, Abilova, Saamay, Erglis, Andrejs, Gilis, Dainus, Nesterovics, Georgijs, Saripo, Vita, Meiere, Ruta, Skudrina, Gunda, Terauda, Elizabete, Jambart, Selim, Ayoub, Carine, Ghaleb, Youmna, Aliosaitiene, Urte, Kutkiene, Sandra, Abdul Kadir, Siti Hamimah Sheikh, Kasim, Noor Alicezah Mohd, Nor, Noor Shafina Mohd, Abdul Hamid, Hasidah, Abdul Razak, Suraya, Al-Khateeb, Alyaa, Abd Muid, Suhaila, Abdul Rahman, Thuhairah, Kasim, Sazzli Shahlan, Radzi, Ahmad Bakhtiar Md, Ibrahim, Khairul Shafiq, Rosli, Marshima Mohd, Razali, Rafezah, Chua, Yung An, Razman, Aimi Zafira, Nazli, Sukma Azureen, Aziz, Nazirul, Rosman, Azhari, Abdul Murad, NorAzian, Jalaludin, Mohd Amin, Abdul Latif, Ahmad Zubaidi, Azzopardi, C., Mehta, Roopa, Martagon, Alexandro J., Ramirez, Gabriela A. Galan, Villa, Neftali E Antonio, Vazquez, Arsenio Vargas, Elias-Lopez, Daniel, Retana, Gustavo Gonzalez, Rodriguez, Betsabel, Macías, Jose J. Ceballos, Zazueta, Alejandro Romero, Alvarado, Rocio Martinez, Portano, Julieta D. Morales, Lopez, Humberto Alvares, Sauque-Reyna, Leobardo, Herrera, Laura G. Gomez, Mendia, Luis E. Simental, Aguilar, Humberto Garcia, Cooremans, Elizabeth Ramirez, Aparicio, Berenice Peña, Zubieta, Victoria Mendoza, Gonzalez, Perla A. Carrillo, Ferreira-Hermosillo, Aldo, Portilla, Nacu Caracas, Dominguez, Guadalupe Jimenez, Garcia, Alinna Y. Ruiz, Cazares, Hector E. Arriaga, Gonzalez, Jesus R., Valencia, Carla V. Mendez, Padilla, Francisco G., Prado, Ramon Madriz, Ibarra, Manuel O. De los Rios, Villicaña, Ruy D. Arjona, Rivera, Karina J. Acevedo, Carrera, Ricardo Allende, Alvarez, Jose A., Martinez, Jose C. Amezcua, Bustillo, Manuel de los Reyes Barrera, Vargas, Gonzalo Carazo, Chacon, Roberto Contreras, Andrade, Mario H. Figueroa, Ortega, Ashanty Flores, Alcala, Hector Garcia, de Leon, Laura E. Garcia, Guzman, Berenice Garcia, Garcia, Jose J. Garduño, Cuellar, Juan C. Garnica, Cruz, Jose R. Gomez, Garcia, Anell Hernandez, Almada, Jesus R. Holguin, Herrera, Ursulo Juarez, Sobrevilla, Fabiola Lugo, Rodriguez, Eduardo Marquez, Sibaja, Cristina Martinez, Rodriguez, Alma B. Medrano, Oyervides, Jose C. Morales, Vazquez, Daniel I. Perez, Rodriguez, Eduardo A. Reyes, Osorio, Ma. Ludivina Robles, Saucedo, Juan Rosas, Tamayo, Margarita Torres, Talavera, Luis A. Valdez, Arroyo, Luis E. Vera, Carrillo, Eloy A. Zepeda, Stroes, Erik S, Defesche, J, Zuurbier, L, Reeskamp, L, Ibrahim, S, Roeters van Lennep, Jeanine, Wiegman, Albert, Isara, Alphonsus, Obaseki, Darlington E., Al-Waili, Khalid, Al-Zadjali, Fahad, Al-Zakwani, Ibrahim, Al-Kindi, Mohammed, Al-Mukhaini, Suad, Al-Barwani, Hamida, Rana, Asim, Shah, Lahore Saeed Ullah, Al-Nouri, Fahad, Starostecka, Ewa, Konopka, Agnieszka, Bielecka-Dabrowa, Agata, Lewek, Joanna, Sosnowska, Bozena, Gąsior, Mariusz, Dyrbuś, Krzysztof, Jóźwiak, Jacek, Pajkowski, Marcin, Romanowska-Kocejko, Marzena, Żarczyńska-Buchowiecka, Marta, Chmara, Magdalena, Wasąg, Bartosz, Stróżyk, Aneta, Michalska-Grzonkowska, Aleksandra, Medeiros, Ana Margarida, Alves, Ana Catarina, Silva, Francisco, Lobarinhas, Goreti, Palma, Isabel, de Moura, Jose Pereira, Rico, Miguel Toscano, Rato, Quitéria, Pais, Patrícia, Correia, Susana, Moldovan, Oana, Virtuoso, Maria João, Araujo, Francisco, Salgado, Jose Miguel, Colaço, Ines, Dumitrescu, Andreea, Lengher, Calin, Mosteoru, Svetlana, Meshkov, Alexey, Ershova, Alexandra, Rozhkova, Tatiana, Korneva, Victoria, Yu, Kuznetsova T., Zafiraki, Vitaliy, Voevoda, Mikhail, Gurevich, Victor, Duplyakov, Dmitry, Ragino, Yulia, Chubykina, Uliana, Shaposhnik, Igor, Alkaf, Fahmi, Khudari, Alia, Rwaili, Nawal, Al-Allaf, Faisal, Alghamdi, Mohammad, Batais, Mohammed A, Almigbal, Turky H, Kinsara, Abdulhalim, AlQudaimi, Ashraf Hammouda Ahmed, Awan, Zuhier, Elamin, Omer A, Altaradi, Hani, Popovic, Ljiljana, Singh, Sandra, Rasulic, Iva, Petakov, Ana, Lalic, Nebojsa M., Lam, Carolyn, Le, Tan Ju, Siang, Eric Lim Tien, Dissanayake, Sanjaya, I-Shing, Justin Tang, Shyong, Tai E, Jin, Terrance Chua Siang, Ting, Sharon Pek Li, Ming, Jeremy Hoe Kian, Drum, Chester Lee, Nastar, Fathima Ashna, Jia, Loh Wann, Ya, Natalie Koh Si, Jie, Marvin Chua Wei, Dalan, Rinkoo, Wei, Yong Quek, sian, Tiong Yee, Keong, Yeo Khung, Rong, Siau Kai, Jin, Darren Seah Ee, Ming, Ian Koh Jan, Chang, Tan Hong, Peng, Fabian Yap Kok, Vasanwala, Rashida Farhad, Raslova, Katarina, Balinth, Karin, Buganova, Ingrid, Fabryova, Lubomira, Kadurova, Michaela, Klabnik, Alexander, Kozárová, Miriam, Sirotiakova, Jana, Battelino, Tadej, Cevc, Matija, Debeljak, Marusa, Torkar, Ana Drole, Fras, Zlatko, Jug, Borut, Cugalj, Barbara Kern, Kovac, Jernej, Mlinaric, Matej, Sikonja, Jaka, Pilcher, Gillian Joan, Blom, D J, Wolmarans, K H, Brice, B C, Muñiz-Grijalvo, Ovidio, Díaz-Díaz, Jose Luis, de Isla, Leopoldo Pérez, Fuentes, Francisco, Badimon, Lina, Martin, François, Miserez, Eleonore B., Shipton, Janine L., Ganokroj, Poranee, Chattranukulchai, Pairoj, Jiamjarasrungsi, Wiroj, Thongtang, Nuntakorn, Krittayaphong, Rungroj, Vathesatogkit, Prin, Sriphrapradang, Chutintorn, Phimphilai, Mattabhorn, Leelawattana, Rattana, Anthanont, Pimjai, Suraamornkul, Swangjit, Deerochanawong, Chaicharn, Senthong, Vichai, Torpongpun, Artit, Suteerayongprasert, Panuwat, Pengpong, Nawarat, Sathavarodom, Nattapol, Sunanta, Usanee, Porntharukchareon, Thachanun, Kiatpanabhikul, Phatharaporn, Kaewkrasaesin, Chatchon, Kongkit, Jaruwan, Umphonsathien, Mongkontida, Akbulut, Mehmet, Alici, Gökhan, Bayram, Fahri, Can, Levent Hürkan, Celik, Ahmet, Ceyhan, Ceyhun, Coskun, Fatma Yilmaz, Demir, Mesut, Demircan, Sabri, Dogan, Volkan, Durakoglugil, Emre, Dural, İbrahim Etem, Gedikli, Omer, Hacioglu, Aysa, Ildizli, Muge, Kilic, Salih, Kirilmaz, Bahadir, Kutlu, Merih, Oguz, Aytekin, Ozdogan, Oner, Onrat, Ersel, Ozer, Savas, Sabuncu, Tevfik, Sahin, Tayfun, Sivri, Fatih, Sonmez, Alper, Temizhan, Ahmet, Topcu, Selim, Tokgozoglu, Lale, Tuncez, Abdullah, Vural, Mirac, Yenercag, Mustafa, Yesilbursa, Dilek, Yigit, Zerrin, Yildirim, Aytul Belgi, Yildirir, Aylin, Yilmaz, Mehmet Birhan, Atallah, Bassam, Traina, Mahmoud, Sabbour, Hani, Abdul Hay, Dana, Luqman, Neama, Elfatih, Abubaker, Abdulrasheed, Arshad, Manla, Yosef, Kwok, See, DellOca, Nicolas, Alieva, Rano B., Fozilov, Khurshid G., Hoshimov, Shavkat U., Nizamov, Ulugbek I., Kan, Liliya E., Kim, Andrey R., Abdullaeva, Guzal J., Abdullaev, Alisher A., Do, Doan Loi, Nguyen, Mai Ngoc Thi, Kim, Ngoc Thanh, Le, Thanh Tung, Le, Hong An, and Ray, Kausik K.

Published
2024
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13. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study

Author

Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R. J., Pinto, Yigal, Gaggin, Hanna K., Wiemer, Jan C., Möckel, Martin, Rutten, Joost H. W., van den Meiracker, Anton H., Gargani, Luna, Pugliese, Nicola R., Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E., Japp, Alan G., Tsanas, Athanasios, Shah, Anoop S. V., Richards, A. Mark, McMurray, John J. V., Mueller, Christian, Januzzi, James L., Mills, Nicholas L., on behalf of the CoDE-HF investigators, Cardiology, ACS - Heart failure & arrhythmias, Internal Medicine, Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, and Mills, N

Subjects
Heart Failure, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Predictive Value of Test, General Medicine, Biomarker, Peptide Fragments, Diagnosis, Differential, Prospective Studie, Observational Studies as Topic, Peptide Fragment, SDG 3 - Good Health and Well-being, Predictive Value of Tests, Natriuretic Peptide, Brain, Humans, Prospective Studies, Biomarkers, Human
Abstract

ObjectivesTo evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics.DesignIndividual patient level data meta-analysis and modelling study.SettingFourteen studies from 13 countries, including randomised controlled trials and prospective observational studies.ParticipantsIndividual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated.Main outcome measureAdjudicated diagnosis of acute heart failure.ResultsOverall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged 75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure.ConclusionsIn an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach.Study registrationPROSPERO CRD42019159407.

Published
2022
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14. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study

Author

Lee, Kuan Ken, primary, Doudesis, Dimitrios, additional, Anwar, Mohamed, additional, Astengo, Federica, additional, Chenevier-Gobeaux, Camille, additional, Claessens, Yann-Erick, additional, Wussler, Desiree, additional, Kozhuharov, Nikola, additional, Strebel, Ivo, additional, Sabti, Zaid, additional, deFilippi, Christopher, additional, Seliger, Stephen, additional, Moe, Gordon, additional, Fernando, Carlos, additional, Bayes-Genis, Antoni, additional, van Kimmenade, Roland R J, additional, Pinto, Yigal, additional, Gaggin, Hanna K, additional, Wiemer, Jan C, additional, Möckel, Martin, additional, Rutten, Joost H W, additional, van den Meiracker, Anton H, additional, Gargani, Luna, additional, Pugliese, Nicola R, additional, Pemberton, Christopher, additional, Ibrahim, Irwani, additional, Gegenhuber, Alfons, additional, Mueller, Thomas, additional, Neumaier, Michael, additional, Behnes, Michael, additional, Akin, Ibrahim, additional, Bombelli, Michele, additional, Grassi, Guido, additional, Nazerian, Peiman, additional, Albano, Giovanni, additional, Bahrmann, Philipp, additional, Newby, David E, additional, Japp, Alan G, additional, Tsanas, Athanasios, additional, Shah, Anoop S V, additional, Richards, A Mark, additional, McMurray, John J V, additional, Mueller, Christian, additional, Januzzi, James L, additional, and Mills, Nicholas L, additional

Published
2022
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15. Development and validation of a decision support tool for the diagnosis of acute heart failure: Systematic review, meta-analysis, and modelling study

Author

Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, Mills, N, Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, Mills, Nicholas L, Lee, K, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, Y, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, Defilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, R, Pinto, Y, Gaggin, H, Wiemer, J, Möckel, M, Rutten, J, van den Meiracker, A, Gargani, L, Pugliese, N, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, D, Japp, A, Tsanas, A, Shah, A, Richards, A, Mcmurray, J, Mueller, C, Januzzi, J, Mills, N, Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, and Mills, Nicholas L

Abstract

Objectives: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. Design: Individual patient level data meta-analysis and modelling study. Setting: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. Participants: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. Main outcome measure: Adjudicated diagnosis of acute heart failure. Results: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged [removed]75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups

Published
2022

16. Development and validation of a decision support tool for the diagnosis of acute heart failure:systematic review, meta-analysis, and modelling study

Author

Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, Mills, Nicholas L, Lee, Kuan Ken, Doudesis, Dimitrios, Anwar, Mohamed, Astengo, Federica, Chenevier-Gobeaux, Camille, Claessens, Yann-Erick, Wussler, Desiree, Kozhuharov, Nikola, Strebel, Ivo, Sabti, Zaid, deFilippi, Christopher, Seliger, Stephen, Moe, Gordon, Fernando, Carlos, Bayes-Genis, Antoni, van Kimmenade, Roland R J, Pinto, Yigal, Gaggin, Hanna K, Wiemer, Jan C, Möckel, Martin, Rutten, Joost H W, van den Meiracker, Anton H, Gargani, Luna, Pugliese, Nicola R, Pemberton, Christopher, Ibrahim, Irwani, Gegenhuber, Alfons, Mueller, Thomas, Neumaier, Michael, Behnes, Michael, Akin, Ibrahim, Bombelli, Michele, Grassi, Guido, Nazerian, Peiman, Albano, Giovanni, Bahrmann, Philipp, Newby, David E, Japp, Alan G, Tsanas, Athanasios, Shah, Anoop S V, Richards, A Mark, McMurray, John J V, Mueller, Christian, Januzzi, James L, and Mills, Nicholas L

Abstract

Abstract:Objectives: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. Design: Individual patient level data meta-analysis and modelling study. Setting: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. Participants: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. Main outcome measure: Adjudicated diagnosis of acute heart failure. Results: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was co

Published
2022

18. Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction

Author

Chiang, Cho-Han, primary, Chiang, Cho-Hung, additional, Pickering, John W., additional, Stoyanov, Kiril M., additional, Chew, Derek P., additional, Neumann, Johannes T., additional, Ojeda, Francisco, additional, Sörensen, Nils A., additional, Su, Ke-Ying, additional, Kavsak, Peter, additional, Worster, Andrew, additional, Inoue, Kenji, additional, Johannessen, Tonje R., additional, Atar, Dan, additional, Amann, Michael, additional, Hochholzer, Willibald, additional, Mokhtari, Arash, additional, Ekelund, Ulf, additional, Twerenbold, Raphael, additional, Mueller, Christian, additional, Bahrmann, Philipp, additional, Buttinger, Nicolas, additional, Dooley, Maureen, additional, Ruangsomboon, Onlak, additional, Nowak, Richard M., additional, DeFilippi, Christopher R., additional, Peacock, William F., additional, Neilan, Tomas G., additional, Liu, Michael A., additional, Hsu, Wan-Ting, additional, Lee, Gin Hoong, additional, Tang, Pui-Un, additional, Ma, Kevin Sheng-Kai, additional, Westermann, Dirk, additional, Blankenberg, Stefan, additional, Giannitsis, Evangelos, additional, Than, Martin P., additional, and Lee, Chien-Chang, additional

Published
2022
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19. Evaluating the effectiveness and risks of oral anticoagulant treatments in multimorbid frail older subjects with atrial fibrillation using the multidimensional prognostic index

Author

Veronese, Nicola, Argusti, Alessandra, Canepa, Elisabetta, Polidori, Maria Cristina, Maggi, Stefania, Strandberg, Timo, Pilotto, Alberto, Marchionni, Nicolò, Durando, Mario, Ferrara, Nicola, Bò, Mario, Barbagallo, Mario, Ruotolo, Giovanni, Heppner, Hans Jurgen, Bahrmann, Philipp, Roller-Wirnsberger, Regina, Pedro, Gil Gregorio, Cruz-Jentoft, Alfonso, da Silva, Pedro Marques, Gruner, Heidi, Berg, Nicolas, Topinkova, Eva, Matejovska-Kubesova, Hana, Nieminen, Tuomo, Pikkarainen, Laura, Rossinen, Juhani, Kearney-Schwartz, Anna, Rewiuk, Krzyszof, Mattace-Raso, Francesco, Olexa, Peter, Internal Medicine, Veronese, Nicola, Argusti, Alessandra, Canepa, Elisabetta, Polidori, Maria Cristina, Maggi, Stefania, Strandberg, Timo, Pilotto, Alberto, Marchionni, Nicolò, Durando, Mario, Ferrara, Nicola, Bò, Mario, Barbagallo, Mario, Ruotolo, Giovanni, Heppner, Hans Jurgen, Bahrmann, Philipp, Roller-Wirnsberger, Regina, Pedro, Gil Gregorio, Cruz-Jentoft, Alfonso, da Silva, Pedro Marque, Gruner, Heidi, Berg, Nicola, Topinkova, Eva, Matejovska-Kubesova, Hana, Nieminen, Tuomo, Pikkarainen, Laura, Rossinen, Juhani, Kearney-Schwartz, Anna, Rewiuk, Krzyszof, Mattace-Raso, Francesco, and Olexa, Peter

Subjects
medicine.medical_specialty, Muldimensional Prognostic Index, Population, law.invention, 03 medical and health sciences, Elderly, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Atrial Fibrillation, medicine, Risk of mortality, 030212 general & internal medicine, Medical prescription, education, Anticoagulants, Frailty, education.field_of_study, business.industry, Anticoagulant, Warfarin, Atrial fibrillation, medicine.disease, Relative risk, Observational study, Geriatrics and Gerontology, business, Gerontology, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: Previous studies suggested that a different risk of mortality may influence the oral anticoagulant prescription in older patients with atrial fibrillation (AF). Recently, the Multidimensional Prognostic Index (MPI) demonstrated a high grade of accuracy, calibration and feasibility to predict mortality in hospitalized and community-dwelling older people. Prognostic information, as calculated by the MPI, however, is not included in the decision algorithm of treatments in older patients with AF Purpose: The aim of this international multicenter prospective observational study was to evaluate whether a different prognostic profile, as determined by the MPI, is associated with different treatments for AF (no treatment vs oral anticoagulants) and differences in the main outcomes, i.e., mortality, major thromboembolic events and side effects. Materials and methods: Older hospitalized patients (age ≥ 65 years) with non-valvular AF will be consecutively enrolled in an European, cross-national, prospective, observational study. At baseline, functional and clinical information will be collected to calculate the MPI, CHA2DS2-VASc score, HAS-BLED score, pharmacological treatments (and the compliance during follow-up) and main and secondary diagnoses. During the 12-month follow-up period, information on survival, major thromboembolic events and major bleeding will be collected. For these aims, a sample size of 3000 people was deemed as sufficient. Conclusions: The EUROSAF study has the main objective of evaluating in a population of hospitalized older subjects with AF the clinical benefit/risk ratio of the oral anticoagulant treatments in terms of mortality, major thromboembolic events and bleeding side-effects, giving important information regarding the appropriate prescription of anticoagulant therapy in this population. ClinicalTrials.gov Identifier: NCT02973984.

Published
2018

34. Turbulent flow as a cause for underestimating coronary flow reserve measured by Doppler guide wire

Author

Richartz Barbara M, Bahrmann Philipp, Werner Gerald S, Ferrari Markus, and Figulla Hans R

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Doppler-tipped coronary guide-wires (FW) are well-established tools in interventional cardiology to quantitatively analyze coronary blood flow. Doppler wires are used to measure the coronary flow velocity reserve (CFVR). The CFVR remains reduced in some patients despite anatomically successful coronary angioplasty. It was the aim of our study to test the influence of changes in flow profile on the validity of intra-coronary Doppler flow velocity measurements in vitro. It is still unclear whether turbulent flow in coronary arteries is of importance for physiologic studies in vivo. Methods We perfused glass pipes of defined inner diameters (1.5 – 5.5 mm) with heparinized blood in a pulsatile flow model. Laminar and turbulent flow profiles were achieved by varying the flow velocity. The average peak velocity (APV) was recorded using 0.014 inch FW. Flow velocity measurements were also performed in 75 patients during coronary angiography. Coronary hyperemia was induced by intra-coronary injection of adenosine. The APV maximum was taken for further analysis. The mean luminal diameter of the coronary artery at the region of flow velocity measurement was calculated by quantitative angiography in two orthogonal planes. Results In vitro, the measured APV multiplied with the luminal area revealed a significant correlation to the given perfusion volumes in all diameters under laminar flow conditions (r2 > 0.85). Above a critical Reynolds number of 500 – indicating turbulent flow – the volume calculation derived by FW velocity measurement underestimated the actual rate of perfusion by up to 22.5 % (13 ± 4.6 %). In vivo, the hyperemic APV was measured irrespectively of the inherent deviation towards lower velocities. In 15 of 75 patients (20%) the maximum APV exceeded the velocity of the critical Reynolds number determined by the in vitro experiments. Conclusion Doppler guide wires are a valid tool for exact measurement of coronary flow velocity below a critical Reynolds number of 500. Reaching a coronary flow velocity above the velocity of the critical Reynolds number may result in an underestimation of the CFVR caused by turbulent flow. This underestimation of the flow velocity may reach up to 22.5 % compared to the actual volumetric flow. Cardiologists should consider this phenomena in at least 20 % of patients when measuring CFVR for clinical decision making.

Published
2006
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36. S2k-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter

Author

Bahrmann, Anke, additional, Bahrmann, Philipp, additional, Baumann, Jeannette, additional, Bauer, Jürgen, additional, Brückel, Elke, additional, Dreyer, Manfred, additional, Freitag, Michael, additional, Friedl, Alexander, additional, Gölz, Stefan, additional, Grundke, Susanne, additional, Hiddemann, Sonja, additional, Hodeck, Katja, additional, Kern, Werner, additional, Kintscher, Ulrich, additional, Kubiak, Thomas, additional, Kulzer, Bernhard, additional, Lee-Barkey, Young, additional, Lobmann, Ralf, additional, Marx, Nikolaus, additional, Schröder, Frank, additional, Tombek, Astrid, additional, Uebel, Til, additional, Wernecke, Jürgen, additional, and Zeyfang, Andrej, additional

Published
2018
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39. Quantification of Renal Function and Cardiovascular Mortality in Patients Admitted to the Emergency Department with Suspected Acute Coronary Syndromes : Results from the TRAPID-AMI Study

Author

Bahrmann, Philipp, Bertsch, Thomas, Giannitsis, Evangelos, Christ, Michael, Hofner, Benjamin, Christenson, Robert, Lindahl, Bertil, Mueller, Christian, Bahrmann, Philipp, Bertsch, Thomas, Giannitsis, Evangelos, Christ, Michael, Hofner, Benjamin, Christenson, Robert, Lindahl, Bertil, and Mueller, Christian

Abstract

Background: Increases in the novel serum marker cystatin C are detectable much earlier in the course of chronic kidney disease (CKD) even when levels of serum creatinine are still in the normal range. A major factor causing a decrease in serum creatinine is increasing age. Patients with CKD are more likely to develop cardiovascular disease (CVD) than a healthy population and to suffer premature deaths from CVD related to CKD. The aim of this study was to investigate whether cystatin C, serum creatinine, and estimated glomerular filtration rate (eGFR) predict cardiovascular mortality in patients admitted to the emergency department (ED) with suspected acute coronary syndromes (ACS). Methods: In 1,282 patients (mean age 62 15 years, 477 women, 805 men) with suspected ACS, baseline cystatin C concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were measured at the ED. Clinical assessment and serial high sensitivity cardiac troponin T (hs-cTnT) measurements were used for the diagnosis of ACS. Seventeen cardiovascular deaths were registered during a median follow-up of 365 days. Results: HRs from univariate Cox regression models for each of the potential biomarkers were 12.02 (95% CI 5.10 - 28.34) for cystatin C, 4.53 (1.75 - 11.70) for serum creatinine, and 0.97 (0.96 - 0.99) for eGFR. All three biomarkers showed a significant association with cardiovascular mortality in univariate analyses. The HRs from a model with all three potential biomarkers were 59.21 (95% CI 9.69 - 361.76) for cystatin C, 0.08 (0.01 - 0.58) for serum creatinine, and 0.98 (0.96 - 1.01) for eGFR. The risk association was significant for ln (cystatin C) and ln (serum creatinine). Conclusions: Results of this prospective study show that the quantification of renal function using cystatin C is useful for predicting cardiovascular mortality in patients with suspected ACS at the ED.

Published
2017
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40. High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Author

Christ, Michael, Bertsch, Thomas, Popp, Steffen, Bahrmann, Philipp, Heppner, Hans-Jürgen, Müller, Christian, Christ, Michael, Bertsch, Thomas, Popp, Steffen, Bahrmann, Philipp, Heppner, Hans-Jürgen, and Müller, Christian

Abstract

Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department

Published
2017

43. Infections in the elderly

Author

Hans Jürgen, Hepper, Cornel, Sieber, Sieber, Cornel, Peter, Walger, Walger, Peter, Philipp, Bahrmann, Bahrmann, Philipp, Katrin, Singler, and Singler, Katrin

Subjects
medicine.medical_specialty, Aging, Sarcopenia, Frail Elderly, Immune senescence, Population, Comorbidity, Critical Care and Intensive Care Medicine, Communicable Diseases, Risk Assessment, Sepsis, Anti-Infective Agents, Activities of Daily Living, medicine, Humans, Functional decline, education, Intensive care medicine, Aged, Aged, 80 and over, education.field_of_study, business.industry, Delirium, General Medicine, medicine.disease, Prognosis, Infectious disease (medical specialty), Acute Disease, Chronic Disease, Disease Progression, business, Case Management
Abstract

Infections have plagued humans since the beginning of recorded history. Huge segments of the human population were episodically wiped out by epidemic infectious diseases in past centuries. Infection was and is often the final cause of mortality in the debilitated elderly. Substantial ongoing research has been performed to investigate mechanisms, causes, pathogenesis, and therapy for infectious disease. Much of this work has involved the elderly because that group is uniquely predisposed to morbidity and mortality from infection. It is hoped that continued research will result in a decrease in infection morbidity and mortality in elderly.

Published
2013

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