Percutaneous coronary intervention (PCI) is performed 300 000 times a year in Germany. Half of these procedures involve patients with chronic coronary syndrome. Little information is available on the quality of decision-making about the indication for PCI in this patient group. The Center for Health Services Research of the German Cardiac Society (Zentrum für kardiologische Versorgungsforschung der Deutschen Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e.V., DGK-ZfKVF), in collaboration with the Initiative on Quality in Medicine (Initiative Qualitätsmedizin e.V., IQM) carried out this study, in which the indication for PCI in randomly selected patients with chronic coronary syndrome was reviewed by peers on site. 441 assessment forms from 16 hospitals were included in the study. More than half of the patients (52.2%) had typical chest pain, 20.1% had mainly dyspnea, 17.7% had chest pain and dyspnea, and 10% had no symptoms. Three-quarters had symptoms or ischemia despite optimal drug treatment. Most patients were treated for clinical symptoms and proven ischemia or stenosis of more than 90%. In 11% of patients, the indication was complete revascularization as a staged procedure after a prior myocardial infarction treated with PCI. 73.7% of indications for PCI were judged to be in adherence to the guidelines; guideline adherence was judged to be questionable in 24.1% and to be absent in 2.2%. These data on the quality of indications for elective PCI reveal a need for improvement in adherence to the recommendations of the current German and international guidelines. In particular, the non-invasive or invasive proof of ischemia should be performed more frequently. These findings underscore the importance of peer review of indications for interventional procedures.
The prevalence of thoracic aortic aneurysms (TAA) varies from 0.01 to 10 per 100 000 people depending on the healthcare sector. Undiagnosed TAA can cause highly lethal complications, such as acute aortic dissection. In this article, we discuss the opportunities for stratified early detection. To assess the benefits and risks of screening in high-risk groups and in the population at large, the prevalence of TAA, as well as the sensitivity, radiation exposure, and burden of various diagnostic techniques, were determined or estimated on the basis of a selective literature review, and the identified correlations were discussed with experts and compared with the current guidelines. The prevalence and risk of TAA in patients with certain concurrent diseases were calculated from data on 394 113 adults (2000-2023) from the SHRN primary care database. Suitable screening methods include computed tomography, magnetic resonance imaging, and, to a limited extent, transthoracic echocardiography. The use of these techniques and the choice among them must be considered individually for each patient. Population-wide screening is not recommended according to current data. Diagnostic testing may be reasonable for persons at elevated risk of TAA (high pretest probability), e.g., those with a family history of TAA or aortic dissection and those with a genetic predisposition, or persons with a bicuspid aortic valve (adjusted odds ratios 43.95 [9.84. 196.5] to 91.8 [18.7; 450.0], depending on age and sex), an abdominal aortic aneurysm (OR 25.6 [13.9; 47.2] to 31.1 [15.9; 60.7]), or giant cell arteritis (OR 4.99 [0.52; 47.5] to 25.3 [3.10; 206.3]). Early detection measures are reasonable for specific patient groups; current treatment guidelines reflect this only to a limited extent. In the future, the sensitivity and specificity of the diagnostic tests used should be estimated more precisely in studies conducted for this purpose, and TAA should be documented as a cause of death in Germany, as in other countries.
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The number of deaths in Germany attributed to heat has risen in recent years. At the same time, winters have become milder, which implies that there may be fewer deaths due to extreme cold. In this study, we estimated the mortality associated with both heat and cold in Germany for the years 2000-2023. We used daily death counts and mean temperature records to estimate the percentage of heat- and cold-associated deaths for the years 2000-2023 by means of a generalized additive model (GAM). We also carried out a meta-analysis to estimate the effect of temperature on the relative mortality risk (exposure-response curve). We confirmed the recent increase in heat-associated mortality already reported elsewhere, while also documenting a decline in cold-associated mortality from approximately 2015 onward. As a result, overall temperature-associated mortality has fallen slightly over the past 10 years. We estimate that 4-5% of deaths are temperature-associated; typically, 3-4% are linked to cold, and just under 1% to heat. The slight decline in temperature-associated mortality does not imply that there is no cause for concern in the future, nor can it be simply extrapolated to future developments. Temperature-associated mortality reflects both the relative mortality risk at a given temperature and the number of days with that temperature. If the number of days with high temperatures continues to rise, adaptation strategies will have to be developed rapidly to prevent a marked rise in heat-related deaths.
Smoking worsens the prognosis of patients with coronary heart disease (CHD). Only limited population-based data are available on smoking cessation and its characteristics in people with CHD. We compared smokers with and without CHD. We analyzed pooled data from nine waves (June 2023-August 2024) of two representative cross-sectional surveys in Germany (DEBRA and OptiCor). We included adults aged 35 years and above who provided information on their smoking behavior and CHD status (n = 11 069; 994 [9%] with CHD). The endpoints included smoking status, tobacco dependence, motivation to quit smoking, and attempts to do so, as well as the use of electronic inhalation products (e-cigarettes, tobacco heaters). Regression models with CHD as an independent variable were adjusted for age, sex, education, and income. People with CHD were less likely to be current smokers (23.8%, 95% confidence interval [21.2; 26.6], versus 29.3% [28.5; 30.2]), but they were more likely to be former smokers (32.2% [29.3; 35.3] versus 18.9% [18.1; 19.6]). Being a smoker with CHD was associated with the use of electronic inhalation products (odds ratio [OR] = 2.53 [1.43; 4.48]), higher motivation to quit smoking (OR = 1.41 [1.02; 1.96]), and greater tobacco dependence (OR = 1.63 [1.05; 2.53]). Among current smokers and those who smoked in the past year, those with CHD were also more likely than those without CHD to have made at least one attempt to quit in the past year (OR = 2.90 [1.98; 4.25]). One-quarter of people with CHD smoke. Despite a greater degree of tobacco dependence, they show higher motivation and make more attempts to quit smoking compared with smokers without CHD. As smoking cessation is crucial in this group, healthcare professionals should consistently assess the smoking status of people with CHD and offer them evidence-based support for smoking cessation.
The optimal use of tranexamic acid (TXA) in trauma care is a matter of intense discussion, particularly with respect to its indications, dosage, temporal window, and thromboembolic adverse effects. This review is based on publications retrieved by a selective literature search on the indications, effects, mechanism of action, and side effects of TXA (January 2022 to December 2025). Three randomized, controlled trials (RCTs), three observational studies, eight secondary analyses, and 16 meta-analyses were evaluated. TXA administration lowers the mortality of severely traumatized patients (e.g., with a relative risk [RR] of 0.73 [0.56;0.96]). The currently available evidence is inconsistent, and many of the effects found in published studies lie within the range of random fluctuation. The reduction of mortality depends on TXA administration at the earliest possible time in the first 90 minutes after trauma (this temporal window is more important than the question of pre- vs. in-hospital administration), as well as on the nature of the injury, particularly in patients with hemorrhagic shock. Among patients with isolated traumatic brain injury, no consistent effect on mortality has been shown, but there may be an effect on the progression of intracranial bleeding. Multiple studies point to a thromboembolic risk, which is dose-dependent, with a marked rise at 4 g (hazard ratio [HR] 5.33, 95% confidence interval [1.94;14.63]). In patients without shock, the reported absolute risk difference for mortality ranges from -5% to +5%, and that for thromboembolic adverse events from -0.2% to +4%. For trauma patients with life-threatening hemorrhage, especially those in hemorrhagic shock, it is recommended that TXA be given as early as possible (before arrival in the hospital) in a single dose of 1-2 g (15-30 mg/kg body weight [BW]). When this is done, the benefit appears to be greater than the thromboembolic risk.
Pyogenic spondylodiscitis is a type of infection of the spine whose incidence is rising in an aging, multimorbid population. The goal of this study is to analyze nationwide trends in Germany regarding the epidemiology, pathogen spectrum, and antimicrobial resistance profile of this disease over the period 2005-2023. All hospital discharges were retrospectively analyzed with nationwide data on German Diagnosis Related Groups (G-DRG). Hospitalizations with a primary ICD-10-GM diagnosis of spinal osteomyelitis, a pyogenic intervertebral disc infection, or discitis, not otherwise specified (M46.2*, M46.3*, M46.4*) were included in the analysis. The age-adjusted incidence was calculated using population data from the Federal Statistical Office of Germany. Pathogen determinations and resistance phenotypes were ascertained from supplementary pathogen codes. 151 544 cases were identified. Over the study period, the age-adjusted incidence doubled (from 5.41 to 10.02 cases per 100 000 persons), the patients' mean age rose from 65.8 to 72.2 years, and the percentage of patients aged 70 or above rose from 42.6% to 62.3%. The mean length of hospital stay decreased, while in-hospital mortality doubled (from 3.25% to 6.79%). Over the same period, the rate of pathogen determination improved. The percentage of cases due to Staphylococcus aureus fell markedly (from 34.5% to 17.2%), while the percentage due to other gram-positive pathogens rose. The percentage of gram-negative pathogens remained stable. Resistant S. aureus isolates became rarer, while resistant Enterobacterales and Enterococci were identified more frequently. There was an overall downward trend in the rate of resistant pathogens in the final six years of the study period, from 14.1% in 2017 to 6.9% in 2023. In Germany, pyogenic spondyodiscitis mainly affects older patients, and the associated in-hospital mortality is rising. Changes in the pathogen spectrum and in resistance patterns indicate the need for corresponding adjustments to empirical treatment regimens.
Antibody-drug conjugates (ADCs) are approved for use in treating certain types of cancer and are now in clinical development for many others, as they are therapeutically effective. Some of these agents commonly cause ocular side effects, typically manifesting themselves as blurred vision or a foreign-body sensation. For this narrative review of the literature, we carried out a database search and a cross-reference search at the German Federal Institute for Drugs and Medical Devices (BfArM) to identify publications on the diagnosis, prevention, and treatment of ocular side effects associated with ADCs. Of the 13 ADCs that have been approved to date, 4 cause ocular side effects in 5% to 89% of patients. Ocular side effects are severe in up to 43% of the cases in which they occur. Appropriate prophylactic measures must be taken to limit their frequency and intensity; these include not wearing contact lenses, using lubricating eye drops multiple times a day, and cooling the eyes during the administration of treatment. Severe ocular side effects can arise despite such measures and require treatment by a specialist. Ocular side effects can be managed successfully by rapid detection and adequate evaluation of their extent followed by proper treatment, thereby enabling the patient's cancer to be treated appropriately. Interdisciplinary collaboration between oncologists and ophthalmologists must be well-coordinated to ensure effective oncological treatment.
People with intellectual disabilities (ID, prevalence ca. 1.04%) have an elevated risk of hearing impairments, which, if untreated, can hinder communication, cognitive development, and social participation. In a project called "HörGeist," we studied the prevalence of hearing impairments and the feasibility and utility of an outreach auditory screening, diagnosis, and intervention program for people with ID in their living and working environments. In an age-stratified cohort study with a total of 1194 subjects, 1053 people with ID (outreach cohort, aged 1-90 years) underwent auditory screening in their living or working environment twice one year apart, and, if indicated, a diagnostic evaluation for a hearing impairment and either an intervention or a referral for outside treatment. To compare utilization, a control cohort of people with ID (141 subjects) was offered screening and auditory diagnostic testing in a clinical setting. Clinically relevant hearing impairments were diagnosed in 44.0% of patients in the outreach cohort; 69.8% of these impairments had not been identified previously. Cerumen obturans affecting hearing was present in 9.9% of the impairments. Approximately one-third of the subjects or their carers overestimated their hearing ability. Screening and diagnostic evaluation yielded a conclusive result in 96.7% of cases. Screening had an estimated 92.3% specificity (95% confidence interval: [89.6; 94.3]) and 96.4% sensitivity ([94.1; 97.8]). None of the subjects in the invited control cohort made use of the auditory screening program. The prevalence of hearing impairments varied depending on sex, age, and type of institution. The prevalence of hearing impairments in people with ID is high, and most cases are unrecognized. A comprehensive outreach program of auditory screening, diagnostic evaluation, and intervention for people with ID appears feasible and justified and would reach more of the affected persons than a simple invitation. It could improve their social participation as well.
Malnutrition carries high morbidity and mortality. Until now, there have been no nationwide data on diagnosis and treatment rates of malnutrition among hospitalized patients in Germany. In this study, nationwide data from health insurance companies are analyzed to assess diagnosis rates, nutritional treatment, and treatment results. Age- and sex-representative health insurance data (2017-2024) from a German database (InGef) were analyzed to ascertain ICD-coded diagnoses for malnutrition and OPS-coded treatment with enteral and parenteral nutrition. The findings were compared in matched cohorts with and without malnutrition. From 2017 to 2024, the percentage of hospitalized patients with diagnosed malnutrition varied from 1.16% to 1.30%; among these patients, 2.77% to 4.45% received OPS-coded enteral or parenteral nutritional treatment. The common main diagnoses among the patients who received treatment included malignancies, gastrointestinal diseases, respiratory diseases, and infectious diseases. An analysis of cohorts matched by age, sex, and Charlson Comorbidity Index revealed that the malnourished patients had a higher 90-day mortality than the control group (18.2% vs. 7.3%) and a higher rate of rehospitalization within 90 days (44.9% vs. 37.8%). The malnourished patients had higher mean health-care costs. This nationwide analysis reveals low diagnosis rates and limited implementation of nutritional treatment among hospitalized patients in Germany, associated with poorer clinical results and higher costs. These findings underscore the need to introduce structured nutritional screening and care pathways in German hospitals.
Mortality data, i.e., information on whether individuals are living or dead and the causes of death, provide essential endpoints for the assessment of disease progression in clinical-epidemiological studies. In Germany, mortality data for scientific research are often available only through municipal offices, and rarely from registries. In this study, we collected and compared mortality data from these two sources. As part of a study on the early detection of lung cancer and pleural mesothelioma, we collected mortality data on patients recruited in 2014-2015 and on control subjects in the general population. These data were obtained from registration and public health offices and (except for the control subjects) through record linkage with the Cancer Registry North Rhine-Westphalia. 448 of the 460 patients consented to follow-up via the cancer registry, and 429 consented to municipal-office-based follow up, as did 197 of the 207 control subjects. Much more effort was needed to collect data from municipal offices than through record linkage with the cancer registry. Over a 5-year period, the percentage of deaths recorded was slightly higher when assessed with data from the cancer registry (51.1% versus 49.7%). Further information on the causes of death was more frequently available through the cancer registry (98% versus 84%). Follow-up data from the cancer registry were generally more informative, and required less organizational effort to collect, than data from municipal offices. Obtaining data from cancer registries is, therefore, preferable for future cancer studies, although nationwide registry structures for mortality data are still lacking.
Chronic kidney disease (CKD) can be asymptomatic for many years and is often diagnosed late. Given the availability of new treatments, the early identification of relevant findings from screening of the kidney markers estimated glomerular filtration rate (eGFR) and albuminuria in the general population is becoming increasingly important. In the NAKO study, self-reported medical diagnoses of kidney disease in 195 182 participants were compared with relevant findings from screening biomarkers (eGFR < 60 mL/min/1.73 m² and albuminuria). For the purpose of comparison, various equations for assessing kidney function were evaluated as well. 2% of the participants reported having received a medical diagnosis of kidney disease, and 2% had an eGFR below 60 mL/min/1.73 m². There was, however, little overlap between these two groups: more than 80% of participants with an eGFR between 30 and 59 mL/min/1,73 m²) did not report any diagnosis of kidney disease. The additional inclusion of data on albuminuria did not materially affect this discrepancy: 6213 persons (17.5% of the cohort) with an abnormal eGFR or urinary albumin-to-creatinine ratio (UACR) did not report any diagnosis of kidney disease. Even among participants whose eGFR was in the range of 30-59 mL/min/1.73 m² and whose UACR was above 300 mg/g, less than half reported having a medically diagnosed kidney disease. These findings indicate a low level of awareness regarding the possible presence of CKD in the general population. Many people with abnormal screening findings needing further investigation due to their potential clinical relevance are unaware that they might be suffering from a kidney disease. As more effective treatments for kidney disease are now available, these findings indicate a need for structured screening and evaluation strategies to promote kidney health.
Physicians need the appropriate experience to be able to reliably diagnose skin diseases in patients with skin of color. This narrative review is based on scientific articles and book chapters about skin of color and comparative studies across skin pigmentation types or ethnic groups that were retrieved by a selective search. Publications up to 2026 were included. Skin of color differs from the lighter skin type that is most common in northern Europe in melanin structure, content, and distribution and in other anatomical respects. Two main aspects require attention in dermatology; the distinction of malignancy from physiological types of hyperpigmentation, and the recognition and treatment of inflammatory skin diseases. Basal cell carcinoma appears to be the most common type of tumor affecting darkly pigmented as well as lighter skin types; squamous-cell carcinoma is more frequent in darker than in lighter skin. Malignant melanoma is reportedly ca. 33 times less common in persons with darker skin, but often in a more advanced stage at the time of diagnosis. Inflammatory skin diseases present differently on darker compared to lighter skin, as erythema is often barely recognizable or invisible. Sequelae such as post-inflammatory hyper-and hypopigmentation, marked scarring, and keloids are often very disturbing for those affected. There have only been a few studies to date on patients with skin of color. Dermatological study findings must be evaluated in an inclusive manner. People with skin of color should also be screened for skin cancer and should protect themselves against the effects of ultraviolet light.
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