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9. Remote Sensing Integration to Geohazard Management at the Castle-Monastery of Panagia Spiliani, Nisyros Island, Greece

Author

Marinos Vassilis, Farmakis Ioannis, Chatzitheodosiou Themistoklis, Papouli Dimitra, Stoumpos Georgios, Prountzopoulos Georgios, and Karantanellis Efstratios

Subjects
LiDAR, UAV, rockfalls, geohazards, cultural heritage, risk, Science
Abstract

The Holy Monastery of Panagia Spiliani is an important religious monument of the Aegean islands. The monastery is built on a steep rocky hill in the Castle of Mandraki on Nisyros island. On the slopes of the foundation area of the monastery, landslides have occurred in the past, mainly rockfalls and slides, while the risk of new similar phenomena in the future is high. To assist the geohazard assessment and mitigation design works, a combined survey using Terrestrial Laser Scanning (TLS) and Unmanned Aerial Vehicle (UAV) photogrammetry was implemented. Besides capturing the detailed morphology within high-resolution 3D point clouds, the main engineering geological units were identified on the slopes, while critical structural ground elements and unstable blocks were mapped in detail. These were quantified in terms of geotechnical parameters, and the engineering geological model of the hill was finalised and presented in an engineering geological map and cross sections. The mitigation measures are targeted towards the stabilisation of the wider area of the upper slope, hence the stability of the monastery and its surroundings risk elements, as well as the support of specific, large- to small-scale unstable rock blocks on the whole slope area, securing accessibility to the main beach of the village.

Published
2024
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18. Abstract 15011: Recent Trends in Interventional Treatment of Acute Pulmonary Embolism and Their Implications for a National Healthcare System

Author

Mohr, Katharina, Farmakis, Ioannis T, Barco, Stefano, Channick, Richard N, Christodoulou, Konstantinos, Giri, Jay S, Hobohm, Lukas, Keeling, Brent, Keller, Karsten, Lanno, Michelle, Lookstein, Robert A, Moriarty, John M, Reed, Jamie, Rosovsky, Rachel P, Rosenfield, Kenneth, Secemsky, Eric A, Todoran, Thomas M, Binder, Harald, and Konstantinides, Stavros V

Published
2023
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20. Atrial High-Rate Episodes in Patients with Devices Without a History of Atrial Fibrillation: a Systematic Review and Meta-analysis

Author

Doundoulakis, Ioannis, Gavriilaki, Maria, Tsiachris, Dimitris, Arsenos, Petros, Antoniou, Christos-Konstantinos, Dimou, Smaro, Soulaidopoulos, Stergios, Farmakis, Ioannis, Akrivos, Evangelos, Stoiloudis, Panagiotis, Notas, Konstantinos, Kimiskidis, Vasilios K., Giannakoulas, George, Paraskevaidis, Stylianos, Gatzoulis, Konstantinos A., and Tsioufis, Konstantinos

Published
2022
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26. Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism

Author

Mohr, Katharina; https://orcid.org/0009-0000-5718-0549, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Kaier, Klaus, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Valerio, Luca; https://orcid.org/0000-0003-4466-0724, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Abele, Christina, Münzel, Thomas; https://orcid.org/0000-0001-5503-4150, Neusius, Thomas; https://orcid.org/0000-0002-5097-9064, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Binder, Harald; https://orcid.org/0000-0002-5666-8662, Keller, Karsten; https://orcid.org/0000-0002-0820-9584, Mohr, Katharina; https://orcid.org/0009-0000-5718-0549, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Kaier, Klaus, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Valerio, Luca; https://orcid.org/0000-0003-4466-0724, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Abele, Christina, Münzel, Thomas; https://orcid.org/0000-0001-5503-4150, Neusius, Thomas; https://orcid.org/0000-0002-5097-9064, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Binder, Harald; https://orcid.org/0000-0002-5666-8662, and Keller, Karsten; https://orcid.org/0000-0002-0820-9584

Abstract

BACKGROUND AND AIMS The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany. METHODS AND RESULTS We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0 days). CONCLUSIONS We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.

Published
2024

27. Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: data from a practice-based longitudinal cohort

Author

Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Paschke, Lena Marie, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Partovi, Sasan, Münzel, Thomas; https://orcid.org/0000-0001-5503-4150, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Keller, Karsten; https://orcid.org/0000-0002-0820-9584, Below, Maike, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Paschke, Lena Marie, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Partovi, Sasan, Münzel, Thomas; https://orcid.org/0000-0001-5503-4150, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Keller, Karsten; https://orcid.org/0000-0002-0820-9584, and Below, Maike

Abstract

BACKGROUND A large prospective multicenter cohort study with systematic follow-up recently reported a 2.3% 2-year cumulative incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). OBJECTIVES The present investigation aimed to determine the reported prevalence and incidence of CTEPH diagnosis after acute PE in real-world practice over a 12-year period. METHODS This study was based on nationwide ambulatory billing claims and drug prescription data of all residents with public health insurance in Germany from 2010 to 2021. RESULTS A total of 573 972 patients with acute PE (median age, 71 years; 57.4% women) were identified between 2010 and 2021. Prevalence of CTEPH among patients with history of PE increased during the period from 0.4% in 2010 to 0.9% in 2021. CTEPH was diagnosed in 2556 patients after acute PE, with most (17.6%) diagnoses reported within the first 3 months after the index PE event. The cumulative incidence rate after 3 months (first quarter) was calculated at 0.08% and after the first 2 years (eighth quarter) at 0.36%; it was 0.75% over the entire (90-month) follow-up period. Patients with CTEPH diagnosis during follow-up more often had right ventricular dysfunction at the index acute PE (14.9% vs 8.3%; P < .001). CONCLUSION The low CTEPH incidence rate after acute PE in the present analysis suggests low awareness of CTEPH. It further suggests a lack of systematic follow-up protocols for acute PE survivors in the real world. Improved implementation of existing recommendations on follow-up strategies after PE is warranted.

Published
2024

28. Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System

Author

Mohr, Katharina; https://orcid.org/0009-0000-5718-0549, Keeling, Brent, Kaier, Klaus, Neusius, Thomas; https://orcid.org/0000-0002-5097-9064, Rosovsky, Rachel P; https://orcid.org/0000-0002-2392-7365, Moriarty, John M; https://orcid.org/0000-0001-8108-520X, Rosenfield, Kenneth; https://orcid.org/0000-0002-5633-6983, Abele, Christina; https://orcid.org/0000-0002-1991-0587, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Keller, Karsten; https://orcid.org/0000-0002-0820-9584, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Channick, Richard N; https://orcid.org/0000-0002-9016-4468, Giri, Jay S; https://orcid.org/0000-0002-8076-0098, Lookstein, Robert A, Todoran, Thomas M; https://orcid.org/0000-0003-1815-5943, Christodoulou, Konstantinos C, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Lanno, Michelle, Reed, Jamie, Binder, Harald; https://orcid.org/0000-0002-5666-8662, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Valerio, Luca; https://orcid.org/0000-0003-4466-0724, Secemsky, Eric A; https://orcid.org/0000-0003-3861-3163, Mohr, Katharina; https://orcid.org/0009-0000-5718-0549, Keeling, Brent, Kaier, Klaus, Neusius, Thomas; https://orcid.org/0000-0002-5097-9064, Rosovsky, Rachel P; https://orcid.org/0000-0002-2392-7365, Moriarty, John M; https://orcid.org/0000-0001-8108-520X, Rosenfield, Kenneth; https://orcid.org/0000-0002-5633-6983, Abele, Christina; https://orcid.org/0000-0002-1991-0587, Farmakis, Ioannis T; https://orcid.org/0000-0002-0586-6386, Keller, Karsten; https://orcid.org/0000-0002-0820-9584, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Channick, Richard N; https://orcid.org/0000-0002-9016-4468, Giri, Jay S; https://orcid.org/0000-0002-8076-0098, Lookstein, Robert A, Todoran, Thomas M; https://orcid.org/0000-0003-1815-5943, Christodoulou, Konstantinos C, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Lanno, Michelle, Reed, Jamie, Binder, Harald; https://orcid.org/0000-0002-5666-8662, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Valerio, Luca; https://orcid.org/0000-0003-4466-0724, and Secemsky, Eric A; https://orcid.org/0000-0003-3861-3163

Abstract

BACKGROUND Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is entering a growth phase in Europe following a steady increase in the United States (US) in the past decade, but the potential economic impact on European healthcare systems remains unknown. METHODS AND RESULTS We built two statistical models for the monthly trend of proportion of CDT among patients with severe (intermediate- or high-risk) PE in the US. The conservative model was based on admission data from the National Inpatient Sample (NIS) 2016-2020, and the model reflecting increasing access to advanced treatment from the PERTTM national quality assurance database registry 2018-2021. By applying these models to the forecast of annual PE-related hospitalizations in Germany, we calculated the annual number of severe PE cases and the expected increase in CDT use for the period 2025-2030. The NIS-based model yielded a slow increase, reaching 3.1% (95% CI 3.0-3.2%) among all hospitalizations with PE in 2030; in the PERT-based model, increase would be steeper, reaching 8.7% (8.3-9.2%). Based on current reimbursement rates, we estimated an increase of annual costs for PE-related hospitalizations in Germany ranging from 15.3 to 49.8 million euros by 2030. This calculation does not account for potential cost savings, including those from reduced length of hospital stay. CONCLUSION Our approach and results, which may be adapted to other European healthcare systems, provide a benchmark for healthcare costs expected to result from CDT. Data from ongoing trials on clinical benefits and cost savings are needed to determine cost-effectiveness and inform reimbursement decisions.

Published
2024

29. Healthcare resource utilisation and associated costs after low-risk pulmonary embolism: pre-specified analysis of the Home Treatment of Pulmonary Embolism (HoT-PE) study

Author

Farmakis, Ioannis T, Kaier, Klaus, Hobohm, Lukas, Mohr, Katharina, Valerio, Luca, Barco, Stefano, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Binder, Harald, Farmakis, Ioannis T, Kaier, Klaus, Hobohm, Lukas, Mohr, Katharina, Valerio, Luca, Barco, Stefano, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, and Binder, Harald

Abstract

BACKGROUND Pulmonary embolism (PE) and its sequelae impact healthcare systems globally. Low-risk PE patients can be managed with early discharge strategies leading to cost savings, but post-discharge costs are undetermined. PURPOSE To define healthcare resource utilisation and overall costs during follow-up of low-risk PE. METHODS We used an incidence-based, bottom-up approach and calculated direct and indirect costs over 3-month follow-up after low-risk PE, with data from the Home Treatment of Patients with Low-Risk Pulmonary Embolism (HoT-PE) cohort study. RESULTS Average 3-month costs per patient having suffered low-risk PE were 7029.62 €; of this amount, 4872.93 € were associated with PE, accounting to 69.3% of total costs. Specifically, direct costs totalled 3019.33 €, and of those, 862.64 € (28.6%) were associated with PE. Anticoagulation (279.00 €), rehospitalisations (296.83 €), and ambulatory visits (194.95 €) comprised the majority of the 3-month direct costs. The remaining costs amounting to 4010.29 € were indirect costs due to loss of productivity. CONCLUSION In a patient cohort with acute low-risk PE followed over 3 months, the majority of costs were indirect costs related to productivity loss, whereas direct, PE-specific post-discharge costs were low. Effective interventions are needed to reduce the burden of PE and associated costs, especially those related to productivity loss.

Published
2024

31. Lipid lowering for prevention of venous thromboembolism: a network meta-analysis.

Author

Farmakis, Ioannis T, Christodoulou, Konstantinos C, Hobohm, Lukas, Konstantinides, Stavros V, and Valerio, Luca

Subjects
VENOUS thrombosis, THROMBOEMBOLISM, PULMONARY embolism, THROMBOEMBOLISM prevention, SUBTILISINS
Abstract

Background and Aims Studies have suggested that statins may be associated with reduced risk of venous thromboembolism (VTE). The aim of the current study was to assess the evidence regarding the comparative effect of all lipid-lowering therapies (LLT) in primary VTE prevention. Methods After a systematic search of PubMed, CENTRAL, and Web of Science up until 2 November 2022, randomized controlled trials (RCT) of statins (high- or low-/moderate-intensity), ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were selected. An additive component network meta-analysis to compare VTE risk during long-term follow-up across different combinations of LLT was performed. Results Forty-five RCTs (n = 254 933 patients) were identified, reporting a total of 2084 VTE events. Compared with placebo, the combination of PCSK9i with high-intensity statin was associated with the largest reduction in VTE risk (risk ratio [RR] 0.59; 95% confidence interval [CI] 0.43–0.80), while there was a trend towards reduction for high-intensity (0.84; 0.70–1.02) and low-/moderate-intensity (0.89; 0.79–1.00) statin monotherapy. Ezetimibe monotherapy did not affect the VTE risk (1.04; 0.83–1.30). There was a gradual increase in the summary effect of VTE reduction with increasing intensity of the LLT. When compared with low-/moderate-intensity statin monotherapy, the combination of PCSK9i and high-intensity statin was significantly more likely to reduce VTE risk (0.66; 0.49–0.89). Conclusions The present meta-analysis of RCTs suggests that LLT may have a potential for VTE prevention, particularly in high-intensity dosing and in combination therapy. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Modelling Costs of Interventional Pulmonary Embolism Treatment: Implications of US Trends for a European Healthcare System

Author

Mohr, Katharina, primary, Keeling, Brent, additional, Kaier, Klaus, additional, Neusius, Thomas, additional, Rosovsky, Rachel P, additional, Moriarty, John M, additional, Rosenfield, Kenneth, additional, Abele, Christina, additional, Farmakis, Ioannis T, additional, Keller, Karsten, additional, Barco, Stefano, additional, Channick, Richard N, additional, Giri, Jay S, additional, Lookstein, Robert A, additional, Todoran, Thomas M, additional, Christodoulou, Konstantinos C, additional, Hobohm, Lukas, additional, Lanno, Michelle, additional, Reed, Jamie, additional, Binder, Harald, additional, Konstantinides, Stavros V, additional, Valerio, Luca, additional, and Secemsky, Eric A, additional

Published
2024
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36. Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial

Author

Zafeiropoulos, Stefanos, Farmakis, Ioannis, Kartas, Anastasios, Arvanitaki, Alexandra, Pagiantza, Areti, Boulmpou, Aristi, Tampaki, Athina, Kosmidis, Diamantis, Nevras, Vassileios, Markidis, Eleftherios, Papadimitriou, Ioannis, Vlachou, Anastasia, Arvanitakis, Konstantinos, Miyara, Santiago J., Ziakas, Antonios, Molmenti, Ernesto P., Kassimis, George, Zanos, Stavros, Karvounis, Haralambos, and Giannakoulas, George

Published
2021
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37. Risk for Recurrent Cardiovascular Events and Expected Risk Reduction With Optimal Treatment 1 Year After an Acute Coronary Syndrome

Author

Zafeiropoulos, Stefanos, Farmakis, Ioannis, Kartas, Anastasios, Arvanitaki, Alexandra, Pagiantza, Areti, Boulmpou, Aristi, Tampaki, Athina, Kosmidis, Diamantis, Nevras, Vassileios, Markidis, Eleftherios, Papadimitriou, Ioannis, Arvanitakis, Konstantinos, Sianos, George, Makedou, Kali, Ziakas, Antonios, Tzikas, Apostolos, Karvounis, Haralambos, and Giannakoulas, George

Published
2020
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38. Effects of dietary interventions on cardiovascular outcomes: a network meta-analysis.

Author

Doundoulakis, Ioannis, Farmakis, Ioannis T, Theodoridis, Xenophon, Konstantelos, Antonis, Christoglou, Maria, Kotzakioulafi, Evangelia, Chrysoula, Lydia, Siargkas, Antonis, Karligkiotis, Apostolos, Kyprianou, Georgia, Mastromanoli, Eleni, Soulaidopoulos, Stergios, Zafeiropoulos, Stefanos, Antza, Christina, Tsiachris, Dimitris, and Chourdakis, Michail

Subjects
*CARDIOVASCULAR disease prevention, *PREVENTIVE medicine, *MEDICAL information storage & retrieval systems, *CARDIOVASCULAR diseases, *MEDITERRANEAN diet, *EVALUATION of medical care, *TREATMENT effectiveness, *CARDIOVASCULAR diseases risk factors, *META-analysis, *SYSTEMATIC reviews, *MEDLINE, *MEDICAL databases, CARDIOVASCULAR disease related mortality
Abstract

Context Next to a large body of epidemiological observational studies showing that the Mediterranean diet (MD) is an important lifestyle determinant of cardiovascular risk, there is less relevant evidence from well-conducted randomized controlled trials (RCTs) with hard cardiovascular outcomes. Objective The objective of the study was to identify the most effective dietary intervention for reducing cardiovascular morbidity and mortality. Data Sources A systematic approach following PRISMA network meta-analyses reporting guidelines was applied to a search of electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions, supplemented by scanning through bibliographies of studies and meetings' abstract material. Inclusion criteria were RCTs conducted in an adult population, investigating the effects of different type of diets or dietary patterns on all-cause mortality and cardiovascular outcomes of interest. Data Extraction Data extraction for each study was conducted by 2 independent reviewers. Data Analysis A frequentist network meta-analysis using a random-effects model was conducted. Death from any cardiovascular cause was defined as the primary outcome. A total of 17 trials incorporating 83 280 participants were included in the systematic review. Twelve articles (n = 80 550 participants) contributed to the network meta-analysis for the primary outcome. When compared with the control diet, only the MD showed a reduction in cardiovascular deaths (risk ratio = 0.59; 95% confidence interval, 0.42–0.82). Additionally, MD was the sole dietary strategy that decreased the risk of major cardiovascular events, myocardial infarction, angina, and all-cause mortality. Conclusions MD may play a protective role against cardiovascular disease and death for primary and also secondary prevention. Systematic Review Registration Center for Open Science, https://doi.org/10.17605/OSF.IO/5KX83 [ABSTRACT FROM AUTHOR]

Published
2024
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40. Biomechanical Evaluation of the Impact of Different Weight Loading Conditions on the Mechanical Environment of the Hip Joint Endoprosthesis

Author

Farmakis, Ioannis-Ilias K., Potsika, Vassiliki T., Pakos, Emilios, Fotiadis, Dimitrios I., Magjarevic, Ratko, Editor-in-Chief, Ładyżyński, Piotr, Series Editor, Ibrahim, Fatimah, Series Editor, Lacković, Igor, Series Editor, Rock, Emilio Sacristan, Series Editor, Lhotska, Lenka, editor, Sukupova, Lucie, editor, and Ibbott, Geoffrey S., editor

Published
2019
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41. A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany

Author

Sagoschen, Ingo, primary, Scibior, Barbara, additional, Farmakis, Ioannis T., additional, Keller, Karsten, additional, Graafen, Dirk, additional, Griemert, Eva-Verena, additional, Vosseler, Markus, additional, Treede, Hendrik, additional, Münzel, Thomas, additional, Knorr, Maike, additional, Gori, Tommaso, additional, Konstantinides, Stavros, additional, and Hobohm, Lukas, additional

Published
2023
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42. Contribution of pressure and flow changes to resistance reduction after pulmonary arterial hypertension treatment: a meta-analysis of 3898 patients

Author

Farmakis, Ioannis T., primary, Baroutidou, Amalia, additional, Patsiou, Vasiliki, additional, Arvanitaki, Alexandra, additional, Doundoulakis, Ioannis, additional, Hobohm, Lukas, additional, Zafeiropoulos, Stefanos, additional, Konstantinides, Stavros V, additional, D'Alto, Michele, additional, Badagliacca, Roberto, additional, and Giannakoulas, George, additional

Published
2023
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43. Temporal Trends in Diagnostic Hemodynamics and Survival of Patients with Pulmonary Hypertension: A Single-Center Study

Author

Papadopoulos, Georgios E., primary, Arvanitaki, Alexandra, additional, Markidis, Eleftherios, additional, Mouratoglou, Sophia Anastasia, additional, Farmakis, Ioannis T., additional, Gourgiotis, Panagiotis, additional, Chrysochoidis Trantas, Thomas, additional, Feloukidis, Christos, additional, Kouparanis, Antonios, additional, Didagelos, Matthaios, additional, Grosomanidis, Vasilis, additional, Ziakas, Antonios, additional, and Giannakoulas, George, additional

Published
2023
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48. Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction

Author

Zafeiropoulos, Stefanos, primary, Farmakis, Ioannis T., additional, Milioglou, Ioannis, additional, Doundoulakis, Ioannis, additional, Gorodeski, Eiran Z., additional, Konstantinides, Stavros V., additional, Cooper, Lauren, additional, Zanos, Stavros, additional, Stavrakis, Stavros, additional, Giamouzis, Grigorios, additional, Butler, Javed, additional, and Giannakoulas, George, additional

Published
2023
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