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Johannes Leiner,1,2 Sven Hohenstein,2 Vincent Pellissier,2 Sebastian König,1,2 Claudia Winklmair,3 Irit Nachtigall,4 Andreas Bollmann,1,2,5 Ralf Kuhlen3,5,6 On behalf of the scientific advisory board of the Initiative of Quality Medicine (IQM)1Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany; 2Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany; 3Initiative of Quality Medicine, Berlin, Germany; 4Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany and Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; 5Helios Health Institute, Berlin, Germany; 6Helios Health, Berlin, GermanyCorrespondence: Ralf Kuhlen, Initiative Qualitaetsmedizin e.V, Alt-Moabit 104, Berlin, 10559, Germany, Tel +49 30 7262 152 - 0, Email ralf.kuhlen@initiative-qualitaetsmedizin.deIntroduction: Reliable surveillance systems to monitor trends of COVID-19 case numbers and the associated healthcare burden play a central role in efficient pandemic management. In Germany, the federal government agency Robert-Koch-Institute uses an ICD-code-based inpatient surveillance system, ICOSARI, to assess temporal trends of severe acute respiratory infection (SARI) and COVID-19 hospitalization numbers. In a similar approach, we present a large-scale analysis covering four pandemic waves derived from the Initiative of Quality Medicine (IQM), a German-wide network of acute care hospitals.Methods: Routine data from 421 hospitals for the years 2019– 2021 with a “pre-pandemic” period (01– 01-2019 to 03– 03-2020) and a “pandemic” period (04– 03-2020 to 31– 12-2021) was analysed. SARI cases were defined by ICD-codes J09-J22 and COVID-19 by ICD-codes U07.1 and U07.2. The following outcomes were analysed: intensive care treatment, mechanical ventilation, in-hospital mortality.Results: Over 1.1 million cases of SARI and COVID-19 were identified. Patients with COVID-19 and additional codes for SARI were at higher risk for adverse outcomes when compared to non-COVID SARI and COVID-19 without any coding for SARI. During the pandemic period, non-COVID SARI cases were associated with 28%, 23% and 27% higher odds for intensive care treatment, mechanical ventilation and in-hospital mortality, respectively, compared to pre-pandemic SARI.Conclusion: The nationwide IQM network could serve as an excellent data source to enhance COVID-19 and SARI surveillance in view of the ongoing pandemic. Future developments of COVID-19/SARI case numbers and associated outcomes should be closely monitored to identify specific trends, especially considering novel virus variants.Graphical Abstract: Keywords: initiative of quality medicine, Germany, COVID-19, SARI, inpatient, hospital network

Purpose At the beginning of the COVID-19 pandemic, SARS-CoV-2 was often compared to seasonal influenza. We aimed to compare the outcome of hospitalized patients with cancer infected by SARS-CoV-2 or seasonal influenza including intensive care unit admission, mechanical ventilation and in-hospital mortality. Methods We analyzed claims data of patients with a lab-confirmed SARS-CoV-2 or seasonal influenza infection admitted to one of 85 hospitals of a German-wide hospital network between January 2016 and August 2021. Results 29,284 patients with COVID-19 and 7442 patients with seasonal influenza were included. Of these, 360 patients with seasonal influenza and 1625 patients with COVID-19 had any kind of cancer. Cancer patients with COVID-19 were more likely to be admitted to the intensive care unit than cancer patients with seasonal influenza (29.4% vs 24.7%; OR 1.31, 95% CI 1.00–1.73 p p = .09). 34.9% of cancer patients with COVID-19 and 17.9% with seasonal influenza died (OR 2.45, 95% CI 1.81–3.32 p Conclusion Among cancer patients, SARS-CoV-2 was associated with a higher risk for in-hospital mortality than seasonal influenza. These findings underline the need of protective measurements to prevent an infection with either COVID-19 or seasonal influenza, especially in this high-risk population.

Background Little is known about delivery of neurosurgical care, complication rate and outcome of patients with high-grade glioma (HGG) during the coronavirus disease 2019 (Covid-19) pandemic. Methods This observational, retrospective cohort study analyzed routine administrative data of all patients admitted for neurosurgical treatment of an HGG within the Helios Hospital network in Germany. Data of the Covid-19 pandemic (March 1, 2020—May 31, 2022) were compared to the pre-pandemic period (January 1, 2016—February 29, 2020). Frequency of treatment and outcome (in-hospital mortality, length of hospital stay [LOHS], time in intensive care unit [TICU] and ventilation outside the operating room [OR]) were separately analyzed for patients with microsurgical resection (MR) or stereotactic biopsy (STBx). Results A total of 1763 patients underwent MR of an HGG (648 patients during the Covid-19 pandemic; 1115 patients in the pre-pandemic period). 513 patients underwent STBx (182 [pandemic]; 331 patients [pre-pandemic]). No significant differences were found for treatment frequency (MR: 2.95 patients/week [Covid-19 pandemic] vs. 3.04 patients/week [pre-pandemic], IRR 0.98, 95% CI: 0.89–1.07; STBx (1.82 [Covid-19 pandemic] vs. 1.86 [pre-pandemic], IRR 0.96, 95% CI: 0.80–1.16, P > .05). Rates of in-hospital mortality, infection, postoperative hemorrhage, cerebral ischemia and ventilation outside the OR were similar in both periods. Overall LOHS was significantly shorter for patients with MR and STBx during the Covid-19 pandemic. Conclusions The Covid-19 pandemic did not affect the frequency of neurosurgical treatment of patients with an HGG based on data of a large nationwide hospital network in Germany. LOHS was significantly shorter but quality of neurosurgical care and outcome was not altered during the Covid-19 pandemic.

Introduction: In the early stages of the global COVID-19 pandemic hospital admissions for acute ischemic stroke (AIS) decreased substantially. As health systems have become more experienced in dealing with the pandemic, and as the proportion of the population vaccinated rises, it is of interest to determine whether the prevalence of AIS hospitalization and outcomes from hospitalization have returned to normal. Patients and methods: In this observational, retrospective cohort study, we compared the prevalence and outcomes of AIS during the first four waves of the pandemic to corresponding pre-pandemic periods in 2019 using administrative data collected from a nationwide network of 76 hospitals that manages 7% of all in-hospital cases in Germany. Results: We included 25,821 AIS cases in the study period (2020/2021) and used 26,295 AIS cases as controls (2019). Compared to pre-pandemic numbers, mean daily AIS admissions decreased only during wave 1 (from 39.6 to 34.1; p Conclusion: In Germany, the COVID-19 pandemic seems to have had a larger effect on nationwide in-hospital AIS care during the early pandemic stages, in which AIS case numbers decreased and case fatality rose. This may reflect a nationwide “learning curve” within health care systems in providing AIS care in times of a pandemic.

Aims Utilizing administrative data may facilitate risk prediction in heart failure inpatients. In this short report, we present different machine learning models that predict in-hospital mortality on an individual basis utilizing this widely available data source. Methods and results Inpatient cases with a main discharge diagnosis of heart failure hospitalized between 1 January 2016 and 31 December 2018 in one of 86 German Helios hospitals were examined. Comorbidities were defined by ICD-10 codes from administrative data. The data set was randomly split into 75/25% portions for model development and testing. Five algorithms were evaluated: logistic regression [generalized linear models (GLMs)], random forest (RF), gradient boosting machine (GBM), single-layer neural network (NNET), and extreme gradient boosting (XGBoost). After model tuning, the receiver operating characteristics area under the curves (ROC AUCs) were calculated and compared with DeLong’s test. A total of 59 074 inpatient cases (mean age 77.6 ± 11.1 years, 51.9% female, 89.4% NYHA Class III/IV) were included and in-hospital mortality was 6.2%. In the test data set, calculated ROC AUCs were 0.853 [95% confidence interval (CI) 0.842–0.863] for GLM, 0.851 (95% CI 0.840–0.862) for RF, 0.855 (95% CI 0.844–0.865) for GBM, 0.836 (95% CI 0.823–0.849) for NNET, and 0.856 (95% CI 9.846–0.867) for XGBoost. XGBoost outperformed all models except GBM. Conclusion Machine learning-based processing of administrative data enables the creation of well-performing prediction models for in-hospital mortality in heart failure patients.

Zusammenfassung Ziel der Studie Die Auswirkungen der COVID-19-Pandemie in 2020 auf die Anzahl der täglichen psychiatrischen Notfallaufnahmen und die stationäre psychiatrische Aufenthaltsdauer wurde mit Vorjahren verglichen. Methodik In einer retrospektiven Studie wurden die 4 Quartale 2020 mehrerer psychiatrischer Kliniken in Deutschland mit den jeweiligen Quartalen von 2018 und 2019 statistisch verglichen. Ergebnisse Insgesamt wurden 73 412 Fälle analysiert. Im 2. Quartal 2020 war die Zahl der täglichen Aufnahmen mit 59,1 signifikant niedriger im Vergleich zum Kontrollzeitraum mit 70,7 (Inzidenzratenverhältnis [95 %-Konfidenzintervall] 0,81 [0,69; 0,96]; p = 0,012). Die Aufenthaltsdauer war zwischen allen Quartalen 2020 im Vergleich zum Kontrollzeitraum numerisch, aber nicht signifikant unterschiedlich. Schlussfolgerung Die COVID-19-Pandemie zeigt deutliche Auswirkungen auf die stationäre psychiatrische Versorgung. Zukünftig muss der Blick stärker auf die Notfall- und Krisenversorgung psychisch erkrankter Menschen gelenkt werden.

Purpose The COVID-19 pandemic has led to global changes in healthcare systems. The purpose of this study was to investigate the effects on surgical care of patients. Methods We performed a retrospective analysis of routine data from the largest hospital group in Germany (68 acute hospitals). Included were inpatients who underwent cholecystectomy between March 19, 2020 (beginning of the first lockdown in Germany) and September 22, 2020. These patients were compared with those treated in the same interval in 2019. Results In the 2020 study period, 4035 patients met the inclusion criteria (2019: 4526 patients). During the first lockdown, there was a significant reduction in the number of cholecystectomies performed (51.1% decrease). More patients with a higher risk profile underwent urgent operations, which were accompanied by a significant increase in conversion from laparoscopic to open cholecystectomy. The patients were treated as inpatients for a longer duration than 2019, and the mortality rate increased significantly to 1.3% (2019: 0.1%). The complication rate also showed a significant increase. After the end of the first lockdown, daily admission rates normalized very quickly. However, it was not possible to fully address the backlog of operations. Conclusion There is still a “patient stagnation” 6 months after the first German lockdown. Extrapolated to the national level, this corresponds to almost 21,000 fewer cholecystectomies performed in Germany in 2020. It remains to be seen whether surgical rates will return to pre-pandemic levels and whether complications will arise in the future due to the lack of operations.

The impact of COVID-19 on urgent and involuntary inpatient admissions, as well as coercive measures, has not been assessed so far. A retrospective study was performed analyzing claims data for inpatient psychiatric admissions between 2018 and 2020 (total n = 64,502) from a large German Hospital network. Whilst the total number of urgent admissions decreased in 2020 (12,383) as compared to 2019 (13,493) and 2018 (13,469), a significant increase in the percentage of urgent admissions was observed in 2020 (62.9%) as compared to 2019 (60.6%) and 2018 (59.7%). Compared to this study period, Odds ratio (OR) for proportion were 0.87 (0.84, 0.91) and 0.91 (0.87, 0.95) for 2018 and 2019, respectively (both p

ZusammenfassungCOVID-19 hat zu umfassenden Veränderungen der Welt, wie wir sie bisher kannten, geführt. Durch den starken Anstieg intensivpflichtiger COVID-Patienten wurden beispielsweise elektive Aufnahmen und Eingriffe verschoben. Aber auch Notfälle wie Myokardinfarkte gingen zurück. Die hier vorliegende Studie hat sich mit den Auswirkungen der COVID-Pandemie auf viszeralchirurgische Notfälle anhand von 5 Indikatoroperationen beschäftigt. Dafür wurden Routinedaten aus 73 Akutkrankenhäusern der Helios-Gruppe ausgewertet. Eingeschlossen wurden die Eingriffe, die zwischen dem 13.03.2020 und 12.03.2021 durchgeführt wurden. Verglichen wurden die Daten mit dem Zeitraum vom 13.03.2019 bis zum 12.03.2020.Die Anzahl der Eingriffe bei schwerwiegenden Notfällen (Ileus, mesenteriale Ischämie und Ulkusperforation) sind konstant geblieben. Die Liegedauer im Krankenhaus war im Pandemiejahr 2020 jedoch signifikant kürzer als im Vergleichsjahr 2019. Die Anzahl der Cholezystektomien und Appendektomien war im Pandemiejahr signifikant geringer als im Vergleichsjahr 2019. Die Outcome-Parameter intensivmedizinische Betreuung, invasive Beatmung und Krankenhausmortalität waren zwischen den beiden Zeiträumen für die untersuchten Eingriffe vergleichbar.

Aims Digital health technologies have the potential to improve patient care sustainably. A digital capturing of patient-reported outcome measures (PROMs) could facilitate patients’ surveillance and endpoint assessment within clinical trials especially in heart failure (HF) patients. However, data regarding the availability of digital infrastructure and patients’ willingness to use digital health solutions are scarce. Therefore, we conducted a survey as part of a digital-based HF registry. Methods and results The Helios Heart registry (H2-registry) has been introduced as a prospective registry being based on digitally augmented processes throughout the whole trial conduction from patients’ selection to data collection and follow-up (FU). Patient-reported outcome measures are captured paper-based at recruitment, but patients are offered two digital solutions for FU. Overall, 125 patients (mean age 67.8 years, 34.4% female) were included in the single-centre run-in phase of 16 weeks. Of them, 52.0% were not interested in any digital contact as part of the FU. If digital PROM capturing was conceivable, a web-based solution (70.0%) was preferred to an application-based approach (30.0%). Discrepancies occurred regarding the availability of email accounts and smartphones. Patients in the non-digital group were older (72.0 years vs. 63.2 years, P Conclusions Our survey illustrated difficulties of implementing a digital FU to record PROMs in a contemporary HF cohort in particular among older patients. Further research is required to specify reasons in case of patients’ unwillingness and to better tailor digital health solutions to patients’ specific needs.

Fast-track concepts have fundamentally changed the perioperative care of patients in the last 30 years. Sufficient evidence is available for these concepts.The aim of this article is to evaluate the dissemination of fast-track concepts in Germany based on routine data.A retrospective analysis of all colorectal resections performed at the Helios Clinics in 2016-2021 was carried out. These were analyzed with respect to the length of hospital stay, intensive care unit occupancy, ventilation proportion, mortality, complication rate and access approach.A transfer to the intensive medical care unit is still the standard in Germany after colorectal resection. For oncological colorectal resection, in particular, two thirds of the patients are still perioperatively treated on the intensive care unit. The duration of inpatient hospital stay for colorectal resection is still excessively long in international comparisons and has also only diminished slowly in recent years (e.g. colon cancer 2016: 18.6 ± 11.9 days and 2021: 13.8 ± 9.3 days). The proportion of open surgical interventions is declining but still accounts for a relevant proportion even 30 years after the implementation of laparoscopy (e.g. colon cancer 2016: 71.10% and 2021: 56.44%). Therefore, the care of patients with colorectal resection still does not seem to be implemented according to the fast-track principle.HINTERGRUND: Fast-Track-Konzepte haben die perioperative Betreuung von Patienten in den letzten 30 Jahren grundlegend verändert. Evidenz für diese Konzepte ist ausreichend vorhanden.Ziel dieses Artikels war es, die Verbreitung von Fast-Track-Konzepten in Deutschland anhand von Routinedaten zu evaluieren.Es wurde eine retrospektive Analyse aller kolorektalen Resektionen der Helios-Kliniken der Jahre 2016 bis 2021 durchgeführt. Diese wurden bezüglich Krankenhausverweildauer, Intensivbelegung, Beatmungsanteil, Mortalität, Komplikationsrate und Zugangsweg analysiert.Eine intensivmedizinische Belegung nach kolorektalen Resektionen ist in Deutschland weiterhin die Regel. Insbesondere bei onkologischen kolorektalen Resektionen werden nach wie vor zwei Drittel der Patienten perioperativ intensivmedizinisch betreut. Die stationäre Liegedauer bei kolorektalen Resektionen ist im internationalen Vergleich weiter überdurchschnittlich lang und auch über die letzten Jahre nur langsam rückläufig (z. B. Kolonkarzinom 2016: 18,6 ± 11,9 Tage/2021: 13,8 ± 9,3). Der Anteil offen-chirurgischer kolorektaler Eingriffe ist rückläufig, macht aber auch 30 Jahre nach Einführung der Laparoskopie einen relevanten Anteil aus (z. B. Kolonkarzinom 2016: 71,10 %/2021: 56,44 %). Die Versorgung von Patienten mit kolorektalen Resektionen scheint demnach weiterhin nicht nach Fast-Track-Prinzipen umgesetzt zu sein.

Zusammenfassung Hintergrund Die Qualitatsindikatoren der Initiative Qualitatsmedizin e.V. (IQM) sind als Aufgreifkriterien zur Identifikation moglicher Verbesserungspotentiale in den teilnehmenden Krankenhausern konzipiert worden. Durch die teils mediale Nutzung der veroffentlichten Qualitatsergebnisse fur externe Qualitatsvergleiche entstand das Anliegen der Mitgliedskrankenhauser, eine weitergehende Risikoadjustierung in der Berechnung der Qualitatsindikatoren zu prufen. In Folge eines Expertenanhorungsverfahrens wurde eine Arbeitsgruppe zur Durchfuhrung von Proberechnungen zur Risikoadjustierung gegrundet. Methode Spezifische Risikoadjustierungsmodelle wurden in der bundesweiten DRG-Statistik des Jahres 2016 entwickelt fur die Indikatoren Sterblichkeit bei Herzinfarkt, Herzinsuffizienz, Hirninfarkt, Pneumonie, und Kolonresektion bei kolorektalem Karzinom. Mittels dieser Modelle wurde die standardisierte Sterblichkeit (standardized mortality ratio - SMR) je Indikator in einer Stichprobe von 172 IQM Mitgliedskrankenhausern anhand der Daten des Jahres 2018 ermittelt. Diese wurde mit der SMR auf Basis einer Alters- und Geschlechtsstandardisierung, welche der IQM-Standard ist, bzgl. der mittleren Tendenz sowie korrelativ verglichen. Die Bewertung der Versorgungsqualitat erfolgte a) als deskriptive Abweichung vom SMR-Wert 1 um mindestens |0,1|, sowie b) durch signifikante Abweichung von 1 anhand des 95%- Konfidenzintervalls. Der Einfluss der spezifischen Risikoadjustierung auf die Veranderung der Bewertung im Vergleich zur Standardmethode wurde fur beide Ansatze (a und b) untersucht. Ergebnisse Die spezifischen Risikomodelle zeigten eine area under the curve zwischen 0,72 und 0,84. Differenzen der medianen SMR zwischen Alters- und Geschlechtsadjustierung und spezifischer Risikoadjustierung je Indikator fielen gering aus (0 bis 0,04), die Spearman-Korrelationen lagen zwischen 0,90 und 0,99. Bzgl. der Bewertung der Versorgungsqualitat als besser, schlechter oder gleich zum Bundesdurchschnitt anderte sich die Bewertung ohne Berucksichtigung der statistischen Signifikanz fur zwischen 3,9% (Sterblichkeit bei Pneumonie) und bis zu 20,6% der Krankenhauser (Sterblichkeit bei Herzinsuffizienz). Bei Berucksichtigung der Konfidenzintervalle wechselten zwischen 1,6% (Sterblichkeit bei Kolonresektion) und 17,4% (Sterblichkeit bei Herzinsuffizienz) der Krankenhauser zwischen Bewertungskategorien. Diskussion Die Implementierung der Risikoadjustierung hat geringe Auswirkungen auf die Verteilung der risikoadjustierten Sterblichkeit in den untersuchten Hausern im Vergleich zur etablierten Methodik; die Bewertung der Versorgungsqualitat als auffallig kann sich jedoch fur einzelne Indikatoren fur bis zu ein Funftel der Hauser andern. Vor dem Hintergrund methodischer wie anwendungspraktischer Uberlegungen empfiehlt die Arbeitsgruppe die Entwicklung einer weitergehenden Risikoadjustierung fur ausgewahlte Indikatoren. Dies sollte von Forschungsarbeiten zur Prufung der Validitat der Abrechnungsdaten fur Qualitatssicherung sowie Bestrebungen zur Verbesserung der Nutzbarkeit dieser Daten fur diese Zwecke begleitet sein.

BACKGROUND Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients’ quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. OBJECTIVE Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. METHODS The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). RESULTS With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform’s functionality and usability. CONCLUSIONS TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth.

Background The full impact of the COVID-19 pandemic on surgical spine care is difficult to assess due to a lack in nationwide evidence from more recent phases of the pandemic. We aimed to describe changes in in-hospital processes associated with spinal fusion procedures in the treatment of spinal infections (SI) during different phases of the pandemic. Methods In this retrospective observational study, we examined the in-hospital prevalence and outcomes of spinal fusion procedures for SI (along with patient characteristics, rates of transfer to intensive care units, and mortality rates) during the first four waves of the pandemic compared with the corresponding prepandemic periods in 2019. We used administrative data from a nationwide network of 76 hospitals managing 7% of all in-hospital cases in Germany. Results We observed no significant change in the prevalence of SI fusion procedures during the pandemic, neither in total numbers (349 vs. 373) nor for each wave separately. On a patient level, we found no differences in age, sex, and the prevalence of paresis, and no relevant differences in associated comorbidities. The rate of mechanical ventilation did not change during any of the examined pandemic waves: it ranged between 9.5 and 18.6% during the pandemic and 3.1 and 16.0% during the corresponding prepandemic control periods. The rate of transfer to intensive care changed only during wave 4 (from 70.4 to 54.8%; p = 0.046) but not in any other pandemic phases. We observed no changes in in-hospital mortality rates (range: 2.9–9.7% vs. 6.2–11.3%) or in duration of hospital stay (range: 26.2–30.8 days vs. 20.8–29.2 days). Conclusions The main finding of our study is that within this nationwide network of spine care centers in Germany, the delivery of surgical treatment of SI by means of spinal fusion procedures was maintained throughout the first four waves of the pandemic. Furthermore, there were no relevant changes in patient demographics, in-hospital processes, and mortality rates.

Aims Several reports indicate lower rates of emergency admissions in the cardiovascular sector and reduced admissions of patients with chronic diseases during the Coronavirus SARS-CoV-2 (COVID-19) pandemic. The aim of this study was therefore to evaluate numbers of admissions in incident and prevalent atrial fibrillation and flutter (AF) and to analyse care pathways in comparison to 2019.Methods A retrospective analysis of claims data of 74 German Helios hospitals was performed to identify consecutive patients hospitalized with a main discharge diagnosis of AF. A study period including the start of the German national protection phase (13 March 2020 to 16 July 2020) was compared to a previous year control cohort (15 March 2019 to 18 July 2019), with further sub-division into early and late phase. Incidence rate ratios (IRRs) were calculated. Numbers of admission per day (A/day) for incident and prevalent AF and care pathways including readmissions, numbers of transesophageal echocardiogram (TEE), electrical cardioversion (CV), and catheter ablation (CA) were analysed.Results During the COVID-19 pandemic, there was a significant decrease in total AF admissions both in the early (44.4 vs. 77.5 A/day, IRR 0.57 [95% confidence interval (CI) 0.54–0.61], P Conclusion During the COVID-19 pandemic, AF admission rates declined significantly, with a more pronounced reduction in incident than in prevalent AF. Overall AF care was maintained during early and late pandemic phases with only minor changes, namely less frequent use of TEE. Confirmation of these findings in other study populations and identification of underlying causes are required to ensure optimal therapy in patients with AF during the COVID-19 pandemic.

AIMS: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS AND RESULTS: Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. CONCLUSION: Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.

Background The aim of our study was to assess the impact the impact of gender and age on reactogenicity to three COVID-19 vaccine products: Biontech/Pfizer (BNT162b2), Moderna (mRNA-1273) and AstraZeneca (ChAdOx). Additional analyses focused on the reduction in working capacity after vaccination and the influence of the time of day when vaccines were administered. Methods We conducted a survey on COVID-19 vaccinations and eventual reactions among 73,000 employees of 89 hospitals of the Helios Group. On May 19th, 2021 all employees received an email, inviting all employees who received at least 1 dose of a COVID-19 to participate using an attached link. Additionally, the invitation was posted in the group’s intranet page. Participation was voluntary and non-traceable. The survey was closed on June 21st, 2021. Results 8375 participants reported on 16,727 vaccinations. Reactogenicity was reported after 74.6% of COVID-19 vaccinations. After 23.0% vaccinations the capacity to work was affected. ChAdOx induced impairing reactogenicity mainly after the prime vaccination (70.5%), while mRNA-1273 led to more pronounced reactions after the second dose (71.6%). Heterologous prime-booster vaccinations with ChAdOx followed by either mRNA-1273 or BNT162b2 were associated with the highest risk for impairment (81.4%). Multivariable analyses identified the factors older age, male gender and vaccine BNT162b as independently associated with lower odds ratio for both, impairing reactogenicity and incapacity to work. In the comparison of vaccine schedules, the heterologous combination ChAdOx + BNT162b or mRNA-1273 was associated with the highest and the homologue prime-booster vaccination with BNT162b with the lowest odds ratios. The time of vaccination had no significant influence. Conclusions Around 75% of the COVID-19 vaccinations led to reactogenicity and nearly 25% of them led to one or more days of work loss. Major risk factors were female gender, younger age and the administration of a vaccine other than BNT162b2. When vaccinating a large part of a workforce against COVID-19, especially in professions with a higher proportion of young and women such as health care, employers and employees must be prepared for a noticeable amount of absenteeism. Assuming vaccine effectiveness to be equivalent across the vaccine combinations, to minimize reactogenicity, employees at risk should receive a homologous prime-booster immunisation with BNT162b2. Trial registration: The study was approved by the Ethic Committee of the Aerztekammer Berlin on May 27th, 2021 (Eth-37/21) and registered in the German Clinical Trials Register (DRKS 00025745). The study was supported by the Helios research grant HCRI-ID 2021-0272.

The impact of the COVID-19 year on the number of daily psychiatric emergency admissions and length of stay was compared with previous years.In a retrospective study, the four quarters of 2020 of several psychiatric hospitals in Germany were statistically compared with the respective quarters of 2018 and 2019.A total of 73,412 cases was analyzed. In the 2The COVID-19 pandemic had a strong impact on inpatient psychiatric care. In the future, multimodal care structures must ensure the care of severely mentally ill people in crisis situations.Die Auswirkungen der COVID-19-Pandemie in 2020 auf die Anzahl der täglichen psychiatrischen Notfallaufnahmen und die stationäre psychiatrische Aufenthaltsdauer wurde mit Vorjahren verglichen.In einer retrospektiven Studie wurden die 4 Quartale 2020 mehrerer psychiatrischer Kliniken in Deutschland mit den jeweiligen Quartalen von 2018 und 2019 statistisch verglichen.Insgesamt wurden 73 412 Fälle analysiert. Im 2. Quartal 2020 war die Zahl der täglichen Aufnahmen mit 59,1 signifikant niedriger im Vergleich zum Kontrollzeitraum mit 70,7 (Inzidenzratenverhältnis [95 %-Konfidenzintervall] 0,81 [0,69; 0,96]; p = 0,012). Die Aufenthaltsdauer war zwischen allen Quartalen 2020 im Vergleich zum Kontrollzeitraum numerisch, aber nicht signifikant unterschiedlich.Die COVID-19-Pandemie zeigt deutliche Auswirkungen auf die stationäre psychiatrische Versorgung. Zukünftig muss der Blick stärker auf die Notfall- und Krisenversorgung psychisch erkrankter Menschen gelenkt werden.

To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021.Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis.We could not demonstrate differences in daily admissions over the course of the pandemic (11.2-12.7 patients vs. 11.9-12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7-17.3% vs. 14.5-18.4%). Cholecystostomy was rare throughout all periods (0-0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4-5.5%). Mortality was generally low (1.5-1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods.The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.

ObjectiveAtrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.MethodsUsing International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.ResultsOf 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, pConclusionsThere are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.

Males have a higher risk for an adverse outcome of COVID-19. The aim of the study was to analyze sex differences in the clinical course with focus on patients who received intensive care. Research was conducted as an observational retrospective cohort study. A group of 23,235 patients from 83 hospitals with PCR-confirmed infection with SARS-CoV-2 between 4 February 2020 and 22 March 2021 were included. Data on symptoms were retrieved from a separate registry, which served as a routine infection control system. Males accounted for 51.4% of all included patients. Males received more intensive care (ratio OR = 1.61, 95% CI = 1.51–1.71) and mechanical ventilation (invasive or noninvasive, OR = 1.87, 95% CI = 1.73–2.01). A model for the prediction of mortality showed that until the age 60 y, mortality increased with age with no substantial difference between sexes. After 60 y, the risk of death increased more in males than in females. At 90 y, females had a predicted mortality risk of 31%, corresponding to males of 84 y. In the intensive care unit (ICU) cohort, females of 90 y had a mortality risk of 46%, equivalent to males of 72 y. Seventy-five percent of males over 90 died, but only 46% of females of the same age. In conclusion, the sex gap was most evident among the oldest in the ICU. Understanding sex-determined differences in COVID-19 can be useful to facilitate individualized treatments.

COVID-19 has led to profound changes in the world as we have known it. Due to the sharp increase in intensive care, COVID patients, elective admissions and interventions have been postponed. But emergencies such as myocardial infarction have also decreased. The present study deals with the effects of the COVID pandemic on visceral surgical emergencies on the basis of 5 indicator operations. Routine data from 73 acute hospitals of the Helios Group were evaluated for this purpose. The interventions that were carried out between March 13, 2020 and March 12, 2021 were included. The data was compared with the period from March 13, 2019 to March 12, 2020. The number of interventions in serious emergencies (ileus, mesenteric ischemia and ulcer perforation) has remained constant. However, the length of stay in hospital in the pandemic year 2020 was significantly shorter than in the reference year 2019. The number of cholecystectomies and appendectomies in the pandemic year was significantly lower than in the reference year 2019. The outcome parameters intensive care, invasive ventilation and hospital mortality were comparable for the two periods for these interventions.COVID-19 hat zu umfassenden Veränderungen der Welt, wie wir sie bisher kannten, geführt. Durch den starken Anstieg intensivpflichtiger COVID-Patienten wurden beispielsweise elektive Aufnahmen und Eingriffe verschoben. Aber auch Notfälle wie Myokardinfarkte gingen zurück. Die hier vorliegende Studie hat sich mit den Auswirkungen der COVID-Pandemie auf viszeralchirurgische Notfälle anhand von 5 Indikatoroperationen beschäftigt. Dafür wurden Routinedaten aus 73 Akutkrankenhäusern der Helios-Gruppe ausgewertet. Eingeschlossen wurden die Eingriffe, die zwischen dem 13.03.2020 und 12.03.2021 durchgeführt wurden. Verglichen wurden die Daten mit dem Zeitraum vom 13.03.2019 bis zum 12.03.2020.Die Anzahl der Eingriffe bei schwerwiegenden Notfällen (Ileus, mesenteriale Ischämie und Ulkusperforation) sind konstant geblieben. Die Liegedauer im Krankenhaus war im Pandemiejahr 2020 jedoch signifikant kürzer als im Vergleichsjahr 2019. Die Anzahl der Cholezystektomien und Appendektomien war im Pandemiejahr signifikant geringer als im Vergleichsjahr 2019. Die Outcome-Parameter intensivmedizinische Betreuung, invasive Beatmung und Krankenhausmortalität waren zwischen den beiden Zeiträumen für die untersuchten Eingriffe vergleichbar.