Simon Fleißner, Heino Stöver, Dirk Schäffer, Heike Wodarz-von Essen, Daniel Deimel, Norbert Wodarz
{"title":"Take-Home Naloxone in Opioid Dependency: An Intervention to Reduce Opioid-Related Deaths.","authors":"Simon Fleißner, Heino Stöver, Dirk Schäffer, Heike Wodarz-von Essen, Daniel Deimel, Norbert Wodarz","doi":"10.3238/arztebl.m2025.0030","DOIUrl":"10.3238/arztebl.m2025.0030","url":null,"abstract":"<p><strong>Background: </strong>There were 2227 drug-related deaths in Germany in 2023, corresponding to a rise of 12% over the previous year and a doubling over the course of a decade. Approximately 60% of these deaths were related to opioid consumption. In this narrative review, we discuss whether take-home naloxone (THN) might lower the mortality of persons with opioid dependency.</p><p><strong>Methods: </strong>This review is based on pertinent publications that were retrieved by a selective search in PubMed.</p><p><strong>Results: </strong>Seven observational studies of the mortality of persons with opioid dependency were included in the analysis. The available evidence for the intervention is on a low level. The studies indicate an overall lowering of mortality even though a significant reduction in drug-related deaths was not always achieved. It was concluded in a meta-analysis of 9 observational studies that 9.2% (95% confidence interval, [5.2; 13.1]) of the THN kits provided were actually used in the first three months to prevent opioid overdose-related death. In a Canadian study, 43% [41; 45] of the naloxone kits that were handed out over a period of 8 years were used and successfully prevented opioid overdose-related death. The latter figures suggest that the use of THN may have been systematically underestimated to date.</p><p><strong>Conclusion: </strong>Demonstrating the efficacy of THN is difficult because of the nature of the research topic. Current evidence implies that THN lowers the mortality of persons with opioid dependence. It is estimated that only about 1.3% of opioid dependent people have been provided with THN in Germany thus far. A major expansion of the provision and use of THN could contribute to a further reduction in opioid-related deaths.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"240-244"},"PeriodicalIF":6.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabienne Kreimer, Ardan M Saguner, Ibrahim Akin, Hendrik Milting, Lars Eckardt, Ibrahim El-Battrawy
{"title":"Arrhythmogenic Right Ventricular Cardiomyopathy: Diagnosis, Risk Stratification, and Treatment.","authors":"Fabienne Kreimer, Ardan M Saguner, Ibrahim Akin, Hendrik Milting, Lars Eckardt, Ibrahim El-Battrawy","doi":"10.3238/arztebl.m2024.0264","DOIUrl":"10.3238/arztebl.m2024.0264","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic heart disease with a prevalence of 1 : 2000 to 1 : 5000. It is characterized by the progressive replacement of heart muscle tissue by fatty and connective tissue. It is associated with a high risk of sudden cardiac death. This review presents the current state of knowledge regarding the diagnostic assessment, risk stratification, and treatment of ARVC.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a search in PubMed using the keywords \"ARVC\" and \"arrhythmogenic right ventricular dysplasia\". Guidelines, clinical registry studies, meta-analyses, and randomized controlled trials were evaluated.</p><p><strong>Results: </strong>The diagnosis is established with the aid of (long-term) ECG, echocardiography, magnetic resonance imaging, and genetic tests. The ARVC risk calculator is used to assess the risk of ventricular arrhythmia. Patients' participation in sports is restricted. Beta-blockers are recommended for patients with extrasystoles or ventricular tachycardia (grade I recommendation). If beta-blockers alone have an insufficient effect, amiodarone, flecainide or sotalol can be added (grade IIa). For patients with recurrent ventricular tachyarrhythmia, catheter ablation is an option (grade IIa). While there is a clear recommendation (grade I) for defibrillator implantation for patients who have survived sudden cardiac death, the ARVC risk calculator should be used for decisionmaking in patients for whom primary prophylactic implantation is considered (recommendation grade IIa).</p><p><strong>Conclusion: </strong>ARVC is associated with an increased risk of sudden cardiac death. Risk assessment remains challenging in the absence of randomized controlled trials, particularly with regard to the primary prophylactic implantation of a defibrillator.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"229-234"},"PeriodicalIF":7.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In Reply.","authors":"Paul Witte, Michael Christ","doi":"10.3238/arztebl.m2025.0026","DOIUrl":"https://doi.org/10.3238/arztebl.m2025.0026","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 9","pages":"m1034"},"PeriodicalIF":6.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilhelm Behringer, Harald Dormann, Martin Pin, Christoph Dodt, Bernhard Kumle, Ulrike von Arnim
{"title":"No Improvement.","authors":"Wilhelm Behringer, Harald Dormann, Martin Pin, Christoph Dodt, Bernhard Kumle, Ulrike von Arnim","doi":"10.3238/arztebl.m2025.0008","DOIUrl":"https://doi.org/10.3238/arztebl.m2025.0008","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 8","pages":"m1028"},"PeriodicalIF":6.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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