scholarly journals Preliminary Analysis of Structured Reporting in the HiGHmed Use Case Cardiology: Challenges and Measures

2021 ◽  
Author(s):  
Aljoscha Kindermann ◽  
Erik Tute ◽  
Sebastian Benda ◽  
Martin Löpprich ◽  
Phillip Richter-Pechanski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Early Stage ◽  
Routine Data ◽  
Structured Reporting ◽  
Use Case ◽  
Data Types ◽  
Clinical Routine ◽  
Cardiology Department ◽  
Shared Information ◽  
Disease Entities

The HiGHmed consortium aims to create a shared information governance framework to integrate clinical routine data. One challenge is the replacement of unstructured reporting (e.g. doctoral letters) with structured reporting in clinical routine. The Heidelberg cardiology department evaluates dynamic PDF forms for structured data reporting of heart failure (HF) patients. In this use case, we aim to identify potential caveats or shortcomings in data processing at an early stage. We employed data mining strategies to detect patterns related to incomplete or false data, which we found to be present among all data types. We then discuss the characteristics of the baseline patient cohort in Heidelberg to find out about specific peculiarities and potential biases, which may be site-specific. Briefly, our patient population is predominantly male (67%), NYHA I & II are the most common severity classes, NYHA IV is missing entirely. Most patients have a dilated cardiomyopathy (DCM) or coronary heart disease (CHD) diagnosed as their cause of HF. Finally, we also analyzed how comorbidities and risk factors relate to specific disease entities of heart failure patients. Family anamnesis was more frequent among cardiomyopathy patients than among CHD patients, who show a more dominating presence of dyslipidemia instead. Generally, the most dominant risk factor was arterial hypertension, while at the other end of the scale alcoholism appears to be underreported.

scholarly journals Platform Patterns—Using Proven Principles to Develop Digital Platforms

2021 ◽  
Author(s):  
Marvin Drewel ◽  
Leon Özcan ◽  
Jürgen Gausemeier ◽  
Roman Dumitrescu
Keyword(s):  
Mechanical Engineering ◽  
Early Stage ◽  
Use Case ◽  
Digital Platforms ◽  
Hands On ◽  
The Future ◽  
Platform Development ◽  
Strategic Options ◽  
Generic Design ◽  
Platform Economy

AbstractHardly any other area has as much disruptive potential as digital platforms in the course of digitalization. After serious changes have already taken place in the B2C sector with platforms such as Amazon and Airbnb, the B2B sector is on the threshold to the so-called platform economy. In mechanical engineering, pioneers like GE (PREDIX) and Claas (365FarmNet) are trying to get their hands on the act. This is hardly a promising option for small and medium-sized companies, as only a few large companies will survive. Small and medium-sized enterprises (SMEs) are already facing the threat of losing direct consumer contact and becoming exchangeable executers. In order to prevent this, it is important to anticipate at an early stage which strategic options exist for the future platform economy and which adjustments to the product program should already be initiated today. Basically, medium-sized companies in particular lack a strategy for an advantageous entry into the future platform economy.The paper presents different approaches to master the challenges of participating in the platform economy by using platform patterns. Platform patterns represent proven principles of already existing platforms. We show how we derived a catalogue with 37 identified platform patterns. The catalogue has a generic design and can be customized for a specific use case. The versatility of the catalogue is underlined by three possible applications: (1) platform ideation, (2) platform development, and (3) platform characterization.

Abstract 065: Cardiac Fibrosis and Heart Failure Caused by DsRed Tetramers Involves the Induction of Tissue Inhibitor of Metalloproteinase-1

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Tsung-Hsien Chen ◽  
Shan-Wen Liu ◽  
Mei-Ru Chen ◽  
Kurt M Lin
Keyword(s):  
Heart Failure ◽  
Cardiac Fibrosis ◽  
Fluorescent Protein ◽  
Early Stage ◽  
Transglutaminase 2 ◽  
Underlying Mechanism ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Tissue Inhibitor ◽  
Cardiac Tissues ◽  
Cardiac Symptoms

Whereas aggregation of intracellular proteins was linked to the initiation of cardiac myopathy, the sequence of participating events, including myocyte apoptosis, autophagy, necrosis and fibrosis as the underlying mechanisms leading to heart failure, was not clear. Green fluorescent protein (GFP) and its derivatives induced cardiac dysfunction in mice when expressed in high quantity; however, the mechanism underlying the aggregation of fluorescent protein leading to heart failure remains unexplored.We created a transgenic mouse with switchable expression of the GFP monomer or the expression of DsRed, a red fluorescent protein (RFP) tetramer that tends to aggregate into a large protein complex. GFP mice were free of cardiac symptoms; in contrast, RFP mice with homozygous DsRed alleles developed myocyte necrosis, carditis, ventricular hypertrophy and fibrosis, left atrium thrombosis, dilated heart failure and death at the age of approximately five months. The hemizygote mice displayed similar symptoms at a later age. The expression of the microtubule-associated protein 1 light chain 3 cleaved isoform II (LC3 II) and transglutaminase 2, and the expression of many myopathy- and fibrosis-related genes were significantly induced in the hearts of two-month-old RFP mice. Together with the findings of increased autophagosomes, lysosomes and dysfunctional mitochondria, these results suggest a marked induction of myocyte autophagy and fibrosis as the main underlying mechanism of heart failure in RFP mice. Interestingly, apoptosis was not elevated in RFP hearts. One of the most up-regulated genes in the early stage RFP heart was the tissue inhibitor of matrix metalloproteinases type 1 (TIMP-1), corroborating the role of TIMP-1 in cardiac remodeling and anti-apoptotic activity. The heart-origin of the morbidity in RFP mice was confirmed by expressing DsRed tetramers specifically in cardiac tissues, and the same phenotypes as in RFP mice were observed. In summary, in cardiac myocytes under the stress of protein aggregation, strong induction of TIMP-1 and down-regulation of MMP activity may play a significant role in enhancing the synthesis of extracellular matrix, resulting in fibrosis and heart failure.

scholarly journals AUTOREGULATION OF BRAIN CIRCULATION IN PROGRESSING CARDIAC FAILURE AND ITS RELATION TO THE APPEARANCE OF SEIZURE READINESS

2016 ◽  
Vol 15 (2) ◽  
pp. 86-93
Author(s):  
M.L. Mamalyga ◽  
◽  
L.M. Mamalyga ◽  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cardiac Failure ◽  
Early Stage ◽  
Brain Circulation ◽  
Brain Disorders ◽  
Compression Tests ◽  
Cardiac Decompensation ◽  
Severe Stage ◽  
Basilar Arteries

On the early stage of cardiac decompensation, the blood flow in common carotid and basilar arteries does not change, however the seizure readiness (SR) of animals increases. The preserved reaction on hypercapnic and compression tests allows us to stipulate that the increased SR is not related to the circulatory brain disorders. Progressive aggravation of cardiac failure (CF) leads to the severe stage of decompensation accompanied by decreased blood flow in common carotid and basilar arteries, as well as increases SR. At the same time the metabolic cascade of autoregulation is areactive and myogenic is significantly decreased. Ineffective operation of heart in different stages of heart failure shows not the same effect or backup possibilities for cerebral hemodynamic autoregulation affecting the formation and aggravation of SR. The increased SR in cardiac failure is not always caused by brain ischemia.

scholarly journals Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244485
Author(s):  
Caroline Verhestraeten ◽  
Gijs Weijers ◽  
Daphne Debleu ◽  
Agnieszka Ciarka ◽  
Marc Goethals ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Practitioner ◽  
General Practitioners ◽  
Early Stage ◽  
Blood Analysis ◽  
Care Process ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Heart Failure Patients

Aims Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. Methods and results The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Conclusions Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.

scholarly journals Extrém magas B típusú natriureticus prohormon prognosztikai szerepe a szívelégtelenség miatt kezelt betegek kórházi halálozására

2017 ◽  
Vol 158 (20) ◽  
pp. 779-782
Author(s):  
Béla Bózsik ◽  
Erzsébet Nagy ◽  
Miklós Somlói ◽  
János Tomcsányi
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Prognostic Value ◽  
Response To Therapy ◽  
Cardiology Department ◽  
The Difference ◽  
One Year

Abstract: Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p<0.001). In the year 2015, we treated 118 patients with an NT-proBNP level above 10 000 ng/l. Thirteen of these patients died, which means that their in-hospital mortality exceeded 10%. In comparison, the in-hospital mortality of all heart failure patients was 5.8%. The difference of median NT-proBNP levels of surviving versus deceased patients in this group with extremely high NT-proBNP levels was no longer significant (17 080 ng/l vs. 19 152 ng/l). Conclusions: Patients with an NT-proBNP level of >10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

scholarly journals EPIDEMILOGICAL, CLINICAL AND ECHOCARDIOGRAPHIC FEATURES OF HEART FAILURE IN MOROCCO

2021 ◽  
Vol 9 (11) ◽  
pp. 521-526
Author(s):  
A. Maliki Alaoui ◽  
◽  
Y. Fihri ◽  
A. Ben El Mekki ◽  
H. Bouzelmat ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Cross Sectional ◽  
Reduced Ejection Fraction ◽  
Cardiology Department ◽  
Common Risk Factors ◽  
The Mean

Heart failure (HF) is a major public issue taking an epidemic dimension globally. Its incidence is continuing to rise because of a growing and aging population. We held a cross-sectional retrospective studyin the cardiology department of Mohamed V military teaching hospital of Rabat in morocco fromSeptember 2019 toSeptember 2021, including 104 patients admitted with HF. The mean age was 68.5 ±10.3year. Hypertension and diabetes mellitus are the most common risk factors. HF with reduced ejection fraction represents about 49%. Forty-four percent had dilated cardiomyopathy. Ischemic heart disease is the first cause of HF.

scholarly journals Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study

2021 ◽  
Author(s):  
Husam Abdel-Qadir ◽  
Felicia Tai ◽  
Ruth Croxford ◽  
Peter C. Austin ◽  
Eitan Amir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Early Stage ◽  
Sequential Therapy ◽  
Cardiovascular Death ◽  
Population Based ◽  
Emergency Department Visits ◽  
Early Stage Breast Cancer ◽  
Administrative Databases ◽  
Breast Cancer Chemotherapy

Background: The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized. Methods: Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by cardiotoxic exposure (anthracycline alone, trastuzumab alone, sequential therapy with both agents) and matched on age with ≤3 cancer-free HF controls to compare baseline characteristics. To study prognosis after HF onset, we conducted a second match on age plus important HF prognostic factors. The cumulative incidence function was used to describe risk of hospitalization or emergency department visits (hospital presentations) for HF and cardiovascular death. Results: A total of 804 women with EBC developed HF after anthracyclines (n=312), trastuzumab (n=112), or sequential therapy (n=380); they had significantly fewer comorbidities than 2411 age-matched HF controls. After the second match, the anthracycline-HF cohort had a similar 5-year incidence of HF hospital presentations (16.5% [95% CI, 12.0%–21.7%]) as controls (17.1% [95% CI, 14.4%–20.1%]); the 5-year incidence was lower than matched controls for the trastuzumab-HF (9.7% [95% CI, 4.7%–16.9%]; controls 16.4% [95% CI, 12.1%–21.3%]; P =0.03) and sequential-HF cohorts (2.7% [95% CI, 1.4%–4.8%]; controls 10.8% [95% CI, 8.9%–13.0%]; P <0.001). At 5 years, the incidence of cardiovascular death was 2.9% (95% CI, 1.2%–5.9%) in the anthracycline-HF cohort vs. 9.5% (95% CI, 6.9%–12.6%) in controls, and 1.7% (0.6%–3.7%) for women developing HF after trastuzumab vs. 4.3% (95% CI, 3.1–5.8%) for controls. Conclusions: Women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF; trastuzumab-treated women who develop HF have better prognosis than matched HF controls.

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