Protecting healthcare personnel and patients over 3 years of COVID-19 : Effective protection by masks and hygiene: What else was effective?

Healthcare professionals, particularly those in test centers, laboratories, or specialized COVID-19 wards, are in danger of becoming infected. Patients with special underlying health conditions are at an increased risk of getting very sick, being hospitalized, or dying from COVID-19. Age is a leading risk factor in this context. Currently, FFP2 (Filtering Facepiece 2, European standard), N95 (US standard), and KN95 (Chinese standard) face masks remain the simplest measure of protection. Coronavirus warning apps installed on smartphones have been recommended for anonymous contact tracing and quickly disrupting chains of infection. Preventive testing two to three times per week for healthcare personnel, on the day of hospital admission for patients, and upon facility entry for visitors has been routinely performed or has been requested from external test centers in most medical institutions. However, vaccination is regarded the most effective protective measure against COVID-19. The general recommendation of the World Health Organization is that countries continue to work toward vaccinating at least 70% of their populations, prioritizing the vaccination of 100% of healthcare workers and 100% of the most vulnerable groups, including people who are over 60 years of age and those who are immunocompromised or have underlying health conditions. The most vulnerable individuals among patients and healthcare workers should be identified and then their vaccination status should be checked and, if necessary, optimized by booster administration. In Germany, seasonal and institutional recommendations for individual protection by face masks, for hygiene measures, and for preventive testing must follow the updated coronavirus protection regulations (Coronavirus-Schutzverordnungen).

[Diagnosis and treatment of cardiac amyloidosis : A position statement of the ESC working group on myocardial and pericardial diseases 2021]. / Diagnose und Behandlung der kardialen Amyloidose : Positionspapier der ESC Working Group on Myocardial and Pericardial Diseases 2021.

Cardiac amyloidosis is still considered a rare disease, although recent data show that it is the cause of cardiac dysfunction more frequently than expected. The diagnosis of cardiac amyloidosis is based on the detection of extracellular deposits of misfolded proteins in the myocardium. This detection can be made invasively or noninvasively and is based on a tentative diagnosis that forms the foundation for further diagnostic measures. As different forms of amyloidosis may have different clinical presentations, suspicion of amyloidosis is often difficult. As not only the diagnostic possibilities have become broader but also new therapeutic possibilities have been tested in clinical studies, the working group on myocardial and pericardial diseases of the European Society of Cardiology (ESC) has set up a working group of experts to compile the current data on the clinical presentation, diagnostics and treatment of patients with cardiac amyloidosis, in order to subsequently develop diagnostic criteria and treatment options for patients with different forms of cardiac amyloidosis by consensus. The aim was to formulate a uniform Europe-wide acceptable concept for essential diagnostics and treatment for this group of patients. Only this will create the foundation for national and international registers and double-blind randomized treatment studies.

[2 years COVID-19 pandemic-What have we learned?] / 2 Jahre COVID-19-Pandemie ­ was haben wir gelernt?

After 2 years and 5 waves of the coronavirus disease 2019 (COVID-19) pandemic in Germany and experience with superspreader events worldwide, we know that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly mutating virus with changing clinical phenotypes. Besides infections of the respiratory tract, which in severe cases are accompanied by pneumonia requiring mechanical ventilation, the involvement of the heart with myocarditis and pericarditis as well as the kidneys have short-term and also long-term consequences. We have learnt to deal with myocarditis and pericarditis in acute infections and after vaccinations, which in rare cases can also lead to myocarditis and pericarditis. Myocarditis with myocytolysis in autopsy specimens or endomyocardial biopsy specimens is rare. In contrast, elevated troponin levels and suspicious cardiac magnetic resonance imaging (MRI) findings are much more frequent. The best preventive measure is a complete double basic vaccination and booster vaccination with an mRNA vaccine. For patients and medical personnel precise information is given with respect to personal protective equipment and behavior (distancing-hygiene-mask-airing rule).

[Treatment of acute heart failure]. / Therapie der akuten Herzinsuffizienz.

Acute heart failure is a symptom complex of heterogeneous etiology. Clinically, it comprises a broad spectrum ranging from hypertensive pulmonary edema in patients with preserved left ventricular systolic function up to cardiogenic shock in patients with severely depressed left ventricular function. The pathophysiology of acute heart failure is based on a mismatch between myocardial pump function and afterload. Besides causal measures, vasodilators and diuretics are the mainstay of therapy. Catecholamines are indicated only when other drugs are unsuccessful. Opioids are often used in clinical practice but should be used cautiously as they are associated with a negative prognosis. Further adjunctive treatment consists of thromboembolism prophylaxis, non-invasive ventilation and in some cases mechanical circulatory support and renal replacement therapy. This article discusses the differential use of these treatment modalities.

[Bypass surgery versus percutaneous coronary intervention in patients with diabetes mellitus]. / Bypasschirurgie versus perkutane koronare Intervention bei Patienten mit Diabetes mellitus.

At present, in patients with diabetes mellitus and coronary multivessel disease no fixed general recommendation can be given in favor or to the disadvantage of surgical revascularization or in favor or to the disadvantage of percutaneous coronary intervention (PCI). In cases with an evidence-based indication for coronary revascularization because of clinical symptoms and/or proven ischemia, both therapeutic alternatives of bypass surgery or PCI are electable. The decision, which method of revascularization to prefer, must be based on close analyses of individual risk profile, individual comorbidity, and individual coronary morphology. With correct indication, both therapeutic methods are equivalent regarding the prognostically important combined endpoint of death, nonfatal myocardial infarction, and stroke. For PCI, however, there is a higher probability of restenosis depending on the complexity of lesion morphology, requiring more often repeat interventions or revascularizations. Before deciding in subfavor of or against a surgical or nonsurgical revascularization procedure, the complexity of the coronary artery disease should be analyzed, for example using the SYNTAX Score. In patients with SYNTAX Scores > or = 33 and no contraindications to bypass surgery, a surgical revascularization should be preferred. In the intermediate group with SYNTAX Scores between 23 und 32, the advantages and disadvantages of bypass surgery or PCI, for instance, the increased probability of restenosis with a higher necessity of repeat revascularizations after PCI, should be extensively discussed with the patient. In patients with SYNTAX Scores between 0 and 22, the nonsurgical, interventional therapy using drug-eluting stents (DES) can be recommended as an equivalent alternative to bypass surgery. In meta-analyses of randomized controlled trials and meta-analyses of large registries with PCI in patients with diabetes mellitus, clear advantages of DES in comparison with bare-metal stents (BMS) could be shown. Especially for patients with diabetes mellitus, there is still no clear evidence in favor of or against a special DES type or in favor of or against a special stent covering. Further sufficiently powered randomized controlled trials with hard clinical endpoints comparing bypass surgery with PCI (e.g., FREEDOM trial) and comparing different types of DES in patients with diabetes mellitus and clear PCI indications must be awaited, before further recommendations can be given.

[ESC/EASD joint guidelines on diabetes and cardiovascular diseases]. / ESC/EASD-Leitlinien zu Diabetes und kardiovaskulären Erkrankungen.

The ESC/EASD (European Society of Cardiology/European Association for the Study of Diabetes) joint Guidelines on diabetes, pre-diabetes, and cardiovascular diseases have, for the first time, addressed diabetes mellitus and cardiovascular diseases (CVD) as a pathophysiological entity in Europe. Based on these guidelines, diabetes mellitus is regarded from the outset to be a cardiovascular disease, whose life-threatening complications myocardial infarction and stroke can only be avoided by an interdisciplinary concerted action. The most important information of these guidelines for the interdisciplinary cooperation of primary-care physicians, diabetologists and cardiologists are the postulations that patients with the main diagnosis diabetes mellitus with or without known CVD should, at regular intervals, be referred to a cardiologist, and patients with the main diagnosis CVD with or without diabetes mellitus should, at regular intervals, be referred to a diabetologist. Of fundamental importance is the prevention of diabetes and CVD by a comprehensive lifestyle modification including smoking cessation, regular physical activity and weight control, flanked by an evidence-based drug therapy. Within the framework of a multimodal risk management, an optimal antihypertensive therapy of a concomitant elevated blood pressure; a statin therapy in case of elevated LDL cholesterol or regardless of an elevated LDL in proven CVD; ACE inhibitors, angiotensin II receptor blockers, or beta-blockers in case of heart failure; and an anticoagulant therapy for the prevention of cardioembolic stroke in patients with atrial fibrillation all have class I recommendations. Concerning the preferred coronary revascularization procedure in diabetics, today no rigid general recommendation can be given in favor of or against coronary bypass surgery, or in favor of or against percutaneous coronary intervention. The decision for a specific revascularization procedure should, in any case, be based on a detailed analysis of the individual coronary anatomy.

[Acute coronary syndrome - a challenge for the cooperation between outpatient and inpatient care]. / Akutes Koronarsyndrom - eine Herausforderung für die Kooperation zwischen ambulanter und stationärer Versorgung.

Acute coronary syndrome (ACS) summarizes all phases of coronary heart disease, which are imminently life-threatening. In clinical practice, these are unstable angina pectoris, acute myocardial infarction, and sudden cardiac death. As the transitions between these clinical entities are smooth, it has been established during the last years to distinguish patients based on ECG findings in groups with (STEMI) and without ST segment elevation (NSTEMI/unstable angina pectoris). Because of the life-threatening character of this disease, continuous monitoring and immediate diagnostic evaluation are mandatory in all patients with suspected ACS. Regularly, this has to be done in the emergency department of a hospital. As the diagnostic and therapeutic management of ACS necessitates rapid decision-making, an optimal cooperation between outpatient and inpatient departments is essential for maximal therapeutic performance. However, it has been shown that only 20-30% of patients admitted to an emergency department with acute chest pain have ACS and only 10-15% have acute myocardial infarction. About 50% of patients presenting with acute chest pain are part of a low-risk group and do not need hospital admission. On the other hand, 2-8% of patients with acute myocardial infarction are misdiagnosed in interdisciplinary emergency departments and discharged too early in spite of an ongoing life-threatening risk. Therefore, chest pain units (CPUs) were founded in many hospitals to optimize the diagnosis and treatment of ACS and the related consumption of financial resources. A task force of the German Society of Cardiology is presently preparing a consensus paper on the basic requirements for CPUs in Germany. The positioning of CPUs at the gateway between outpatient and inpatient care and the additional need for short-term outpatient exercise testing (stress ECG, stress echocardiography, scintigraphy, stress MRI) after ruling out ACS and myocardial infarction, predestine these facilities for new models of managed care including cardiologists in private practice.

[Policy paper nuclear cardiology - update 2018 - Current status of clinical practice]. / Positionspapier Nuklearkardiologie ­ Update 2018.

The joint position paper of the working community "Cardiovascular Nuclear Medicine" of the German Society of Nuclear Medicine (DGN) and the working group "Nuclear Cardiology Diagnostics" of the German Cardiac Society (DKG) updates the former 2009 paper. It is the purpose of this paper to provide an overview about the application fields, the state-of-the-art and the current value of nuclear cardiology imaging. The topics covered are chronic coronary artery disease, including viability imaging, furthermore cardiomyopathies, infective endocarditis, cardiac sarcoidosis and amyloidosis.

[Myokard-Perfusions-SPECT. Myocardial perfusion SPECT - Update S1 guideline]. / Myokard-Perfusions-SPECT. Update S1-Leitlinie1.

The S1 guideline for myocardial perfusion SPECT has been published by the Association of the Scientific Medical Societies in Germany (AWMF) and is valid until 2/2022. This paper is a short summary with comments on all chapters and subchapters wich were modified and amended.