Herz最新文献

{"title":"[Healthcare 4.0-Medicine in transition].","authors":"Steffen Roßkopf, Benjamin Meder","doi":"10.1007/s00059-024-05267-w","DOIUrl":"10.1007/s00059-024-05267-w","url":null,"abstract":"<p><p>Healthcare 4.0 describes the future transformation of the healthcare sector driven by the combination of digital technologies, such as artificial intelligence (AI), big data and the Internet of Medical Things, enabling the advancement of precision medicine. This overview article addresses various areas such as large language models (LLM), diagnostics and robotics, shedding light on the positive aspects of Healthcare 4.0 and showcasing exciting methods and application examples in cardiology. It delves into the broad knowledge base and enormous potential of LLMs, highlighting their immediate benefits as digital assistants or for administrative tasks. In diagnostics, the increasing usefulness of wearables is emphasized and an AI for predicting heart filling pressures based on cardiac magnetic resonance imaging (MRI) is introduced. Additionally, it discusses the revolutionary methodology of a digital simulation of the physical heart (digital twin). Finally, it addresses both regulatory frameworks and a brief vision of data-driven healthcare delivery, explaining the need for investments in technical personnel and infrastructure to achieve a more effective medicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"350-354"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in cardiovascular imaging and intervention.","authors":"Sandy Engelhardt, Salman Ul Hussan Dar, Lalith Sharan, Florian André, Eike Nagel, Sarina Thomas","doi":"10.1007/s00059-024-05264-z","DOIUrl":"10.1007/s00059-024-05264-z","url":null,"abstract":"<p><p>Recent progress in artificial intelligence (AI) includes generative models, multimodal foundation models, and federated learning, which enable a wide spectrum of novel exciting applications and scenarios for cardiac image analysis and cardiovascular interventions. The disruptive nature of these novel technologies enables concurrent text and image analysis by so-called vision-language transformer models. They not only allow for automatic derivation of image reports, synthesis of novel images conditioned on certain textual properties, and visual questioning and answering in an oral or written dialogue style, but also for the retrieval of medical images from a large database based on a description of the pathology or specifics of the dataset of interest. Federated learning is an additional ingredient in these novel developments, facilitating multi-centric collaborative training of AI approaches and therefore access to large clinical cohorts. In this review paper, we provide an overview of the recent developments in the field of cardiovascular imaging and intervention and offer a future outlook.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"327-334"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Telemedical care concepts for heart failure: status and future].","authors":"F Koehler, M Hiddemann, M Koehler, K Koehler, S Spethmann, T Kaas, B Zippel-Schultz, T M Helms","doi":"10.1007/s00059-024-05266-x","DOIUrl":"10.1007/s00059-024-05266-x","url":null,"abstract":"<p><p>Telemedical care concepts provide opportunities to improve the care of patients with chronic heart failure (CHF). The current state of telemedical technologies enables the effective monitoring of the disease. Germany is one of the first European countries with an entitlement to telemedical supporting care for CHF patients. The decision of the German Federal Joint Committee in 2020 to introduce telemedical supporting care for CHF patients marks a milestone. For the first time, a digital care procedure was included in the benefits catalogue of the statutory health insurance funds due to its proven benefits in terms of morbidity and mortality. Privately insured CHF patients have been entitled to these benefits since January 2024. Future developments, particularly with respect to artificial intelligence procedures in telemedicine, are promising but require more evidence. Further research, technological innovation and supportive policy frameworks are needed to realize the full potential of these approaches. Continued collaboration between healthcare professionals, technology developers and policy makers will be crucial in sustainably improving the care of heart failure patients with telemedicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"342-349"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[eHealth: digital bridges in the healthcare system].","authors":"Simon Glück, Christian Perings","doi":"10.1007/s00059-024-05265-y","DOIUrl":"10.1007/s00059-024-05265-y","url":null,"abstract":"<p><p>Healthcare in Germany is divided into various service sectors, which differ in terms of outpatient and inpatient care as well as the legal and financial bases. The resulting breaks in consecutive patient care are to be overcome by integrating services into cross-sectoral processes (integrated care). Digitalization and the associated use of information and communication technology (ICT) play a decisive role in this. To derive implications and benefits it is necessary to classify the technical possibilities. For this purpose, eHealth is the basic generic term for all process support and direct patient applications that are based on the electronic exchange of data. A distinction can be made between technology for process support and technology for direct application on the patient. Applications in all categories are suitable for ensuring that interfaces in the flow of information between those involved in healthcare processes are adequately managed by eHealth. Furthermore, the allocation of specialized medicine through eHealth is independent of location and sector. New possibilities for generating and using structured data for evidence development and care research are realized through eHealth and the development of existing and new care models will be promoted.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"335-341"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lifelong learning in cardiology: success through innovation : Use of e-learning in further education and training].","authors":"A A Derda, A Hohneck","doi":"10.1007/s00059-024-05263-0","DOIUrl":"10.1007/s00059-024-05263-0","url":null,"abstract":"<p><p>Lifelong learning in cardiology is essential, as treatment standards, technologies and drug treatment are constantly evolving. In this respect e‑learning plays a central role, enabling doctors to flexibly and efficiently expand their knowledge. There are various offerings, from medical students and specialist training to highly specialised expert knowledge. The e‑learning platforms have become an indispensable tool in specialist training. Another concept is the combination of face-to-face teaching and e‑learning, known as blended learning. This is particularly effective in medical training. These models enable flexible preparation and follow-up and appeal to different types of learners. Overall, e‑learning offers a valuable resource for flexibly and efficiently acquiring knowledge and keeping up to date.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"321-326"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to: Artificial intelligence in cardiovascular imaging and intervention.","authors":"Sandy Engelhardt, Salman Ul Hussan Dar, Lalith Sharan, Florian André, Eike Nagel, Sarina Thomas","doi":"10.1007/s00059-024-05271-0","DOIUrl":"10.1007/s00059-024-05271-0","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"393"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of disease in Germany attributed to ambient particulate matter pollution","authors":"Omar Hahad, Jos Lelieveld, Sadeer Al-Kindi, Volker H. Schmitt, Lukas Hobohm, Karsten Keller, Martin Röösli, Marin Kuntic, Andreas Daiber","doi":"10.1007/s00059-024-05269-8","DOIUrl":"https://doi.org/10.1007/s00059-024-05269-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Ambient fine particulate matter pollution with a diameter less than 2.5 micrometers (PM_2.5) is a significant risk factor for chronic noncommunicable diseases (NCDs), leading to a substantial disease burden, decreased quality of life, and deaths globally. This study aimed to investigate the disease and mortality burdens attributed to PM_2.5 in Germany in 2019.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Data from the Global Burden of Disease (GBD) Study 2019 were used to investigate disability-adjusted life–years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to ambient PM_2.5 pollution in Germany.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In 2019, ambient PM_2.5 pollution in Germany was associated with significant health impacts, contributing to 27,040 deaths (2.82% of total deaths), 568,784 DALYs (2.09% of total DALYs), 135,725 YLDs (1.09% of total YLDs), and 433,058 YLLs (2.92% of total YLLs). The analysis further revealed that cardiometabolic and respiratory conditions, such as ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus, were the leading causes of mortality and disease burden associated with ambient PM_2.5 pollution in Germany from 1990–2019. Comparative assessments between 1990 and 2019 underscored ambient PM_2.5 as a consistent prominent risk factor, ranking closely with traditional factors like smoking, arterial hypertension, and alcohol use contributing to deaths, DALYs, YLDs, and YLLs.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Ambient PM_2.5 pollution is one of the major health risk factors contributing significantly to the burden of disease and mortality in Germany, emphasizing the urgent need for targeted interventions to address its substantial contribution to chronic NCDs.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the efficacy of renal denervation in patients with resistant arterial hypertension","authors":"Ocílio Ribeiro Gonçalves, Francinny Alves Kelly, José Guilherme Maia, Artur de Oliveira Macena Lôbo, Vitor Kendi Tsuchiya Sano, Maria Eduarda Cavalcanti Souza, Francisco Cezar Aquino de Moraes, Nimra Farid, Arlindo Bispo da Silva Júnior, Avelar Alves da Silva","doi":"10.1007/s00059-024-05268-9","DOIUrl":"https://doi.org/10.1007/s00059-024-05268-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN has emerged as an alternative for patients with resistant HTN. However, the clinical efficacy of RDN remains incompletely elucidated.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing the use of RDN with sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I² statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. <i>P</i> values of &lt;0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD −3.53 mm Hg; 95% CI −5.94 to −1.12; <i>p</i> = 0.004; I² = 74%) and DBP (MD −1.48 mm Hg; 95% CI −2.56 to −0.40; <i>p</i> = 0.007; I² = 51%). Regarding serum creatinine (MD −2.51; 95% CI −7.90 to 2.87; <i>p</i> = 0.36; I² = 40%), there was no significant difference between RDN and control groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"20 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rechtliche Aspekte in der digitalen Kardiologie","authors":"S. Manteufel, D. Duncker","doi":"10.1007/s00059-024-05262-1","DOIUrl":"https://doi.org/10.1007/s00059-024-05262-1","url":null,"abstract":"<p>Digitale Helfer sind inzwischen ein unverzichtbares Werkzeug in der modernen Kardiologie. Der damit einhergehende technologische Fortschritt bietet hierbei ein ausgesprochenes Potenzial, die Effizienz medizinischer Prozesse zu steigern, in kürzester Zeit präzisere Diagnosen zu ermöglichen und damit die Patientenversorgung zu verbessern. Doch mit der zunehmenden Integration digitaler Helfer im sonst arbeitsintensiven kardiologischen Berufsalltag ergeben sich auch neue Herausforderungen und Fragestellungen, insbesondere im Hinblick auf den Umgang mit dem Thema Recht. Der vorliegende Übersichtsartikel zielt darauf ab, ein Bewusstsein für einzelne juristische Themen zu schaffen, die aus der Verwendung digitaler Technologien in der Kardiologie resultieren. Dabei wird es im Kern um den wohlüberlegten Umgang mit den haftungsrechtlichen Themen der Therapiefreiheit, des kardiologischen Facharztstandards, der ärztlichen Schweigepflicht wie auch des Datenschutzes gehen. Die Integration digitaler Helfer in der Kardiologie führt insgesamt zu einer spürbaren Verbesserung der Effizienz und Qualität der Patientenversorgung, beinhaltet jedoch gleichzeitig eine Vielzahl rechtlicher Herausforderungen, die sorgfältig adressiert werden müssen.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":"40 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is an accurate self-perceived health risk beneficial for patients to minimize prehospital delay time at onset of a ST-segment elevated myocardial infarction (STEMI)?","authors":"Karl-Heinz Ladwig, Elisabeth Olliges, Loai Albarqouni, Sophia Hoschar, Wenlin Ma, Xiaoyan Fang","doi":"10.1007/s00059-024-05256-z","DOIUrl":"10.1007/s00059-024-05256-z","url":null,"abstract":"<p><p>High risk perception (HRP) is fundamental for adequate health behavior. However, its impact on rapid access to cardiac care after the onset of acute myocardial infarction (AMI) is not known. Conflicting evidence exists about sources that promote HRP. Data on sociodemographic and clinical characteristics of 588 AMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study were collected at the bedside. Adjusted multivariate logistic regression models identified factors associated with HRP. Only 13.4% (n = 79) of patients had a favorable HRP level. The HRP patients did not differ from those with low risk perception (LRP) in terms of sex, age, other sociodemographic features, and somatic risk factors. Among the univariate contributors to HRP were prodromal chest pain (p = 0.0004), symptom mismatch during AMI (p < 0.0001), depression (p = 0.01), and anxiety (p = 0.005). However, family history of AMI, a previous AMI, and knowledge of AMI remained significant in the multivariate regression model. Median delay time to reach a hospital-based emergency facility after the onset of AMI was 127 min (interquartile range [IQR]: 83-43, p = 0.02) in HRP patients and 216 min (IQR: 106-721) in LRP patients. An increasing risk perception score was associated with a corresponding stepwise decline in median delay time (p > 0.004). Self-perceived AMI risk is associated in a dose-response relationship with the time needed to reach coronary care emergency facilities. Recurrent AMI, family history of AMI, and sufficient knowledge of MI contribute to risk perception, whereas somatic risk factors do not.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"270-276"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}