[Constellations of findings and derived treatment interventions in telemedical monitoring of patients with heart failure, cardiac arrhythmia or increased risk for sudden cardiac death : Recommendations of the working group 33 telemonitoring of the German Cardiac Society]. / Befundkonstellation und abgeleitete Behandlungsinterventionen bei telemedizinisch überwachten Patienten mit Herzinsuffizienz, Herzrhythmusstörungen oder erhöhtem Risiko für den plötzlichen Herztod : Empfehlungen der Arbeitsgruppe 33 Telemonitoring der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e. V.

The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac arrhytmia or increased risk of sudden cardiac death. The following article summarizes the possibilities of telemonitoring from a technical and organizational point of view and descibes basic requirements on SOPs. these basic requirements should be further specified and anchored in the organizational structure of the individual telemonitoring concept. Moreover, they should de understood as a basic guideline fpr the actions of telemonitoring center (TMC) employees.

[Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. / Positionspapier Telemonitoring : Von den Nukleusmitgliedern der AG33 Telemonitoring in der DGK und assoziierten Mitgliedern.

The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.

[Basic structural features of a cardiac telemedicine center for patients with heart failure and implanted devices, cardiac arrhythmias, and increased risk of sudden cardiac death : Recommendations of the working group 33 Telemonitoring of the German Cardiac Society]. / Grundlegende Strukturmerkmale eines kardiologischen Telemedizinzentrums für Patienten mit Herzinsuffizienz und implantierten Devices, Herzrhythmusstörungen und erhöhtem Risiko für den plötzlichen Herztod : Empfehlungen der Arbeitsgruppe 33 Telemonitoring in der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e. V.

Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the imbalance between the need for treatment and the provision of care is growing. Telemonitoring/telemedicine offers patients in rural or remote areas access to high-quality health care and enables fast access to specialists. The working group 33 Telemonitoring of the German Cardiac Society describes the characteristics and possible applications of telemonitoring/telemedicine in the treatment of patients with heart failure. Furthermore, quality criteria for cardiological telemedicine centres are defined. In addition to the personnel structure of a telemedicine centre and the competencies of employees, requirements for the technical infrastructure and the management of incoming data and alarms are described.

[The telemedical service centre as an essential element of the conceptual approach for telemonitoring of cardiac patients : Requirements on the service, quality, and technical realization of telemonitoring]. / Das Telemedizinische Zentrum als essenzieller Baustein konzeptioneller Ansätze zum Telemonitoring kardialer Patienten : Anforderungen an Leistungen, Qualität und technische Umsetzung von Telemonitoring.

Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.

[Differentiated antiplatelet therapy for acute coronary syndromes]. / Differenzierte antithrombozytäre Therapie bei akutem Koronarsyndrom.

Dual antiplatelet therapy is the cornerstone of maintenance medication following invasive treatment of patients with acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. The debate was enriched by the results of the large phase III clinical trials for prasugrel (TRITON) and ticagrelor (PLATO) compared to clopidogrel in patients with acute coronary syndromes. This article summarizes the critical details und subanalyses of both study programmes and highlights on clinical decision making when using the three P2Y12 blockers in acute coronary syndromes. A special focus is on higher risk patients such as those with ST elevation myocardial infarction and those with coexisting diabetes, but also on minimizing relevant bleedings, which are common during more intense platelet inhibition.

[Challenges of interdisciplinary collaboration in the management of rare diseases]. / Herausforderungen in der interdisziplinären Zusammenarbeit bei der Versorgung seltener Erkrankungen.

The care of patients with rare diseases is associated with many challenges, in particular those associated with high coordination complexity. In an explorative case study in a health-care network for patients with respiratory insufficiency, we have investigated the types and causes of coordination problems.We conducted semi-structured, qualitative interviews with 3 patients and their health-care providers. The evaluation of the views expressed in these interviews was worked up by applying qualitative content analysis.The network examined exhibits parallel structures. While the patient-centred interactions are ensuring patient care, learning processes among the health-care professionals take place and ideas for improved treatment are developed. Depending on the purpose, context-specific interaction patterns are evolving. Causes for coordination problems have been identified at the micro-, meso-, macro- and the indication-based levels, e. g., the low prevalence of the diseases and the lacking qualifications of the health-care professionals.Our results demonstrate the need for creating innovative health-care structures. Potential solutions range from the initiation of interdisciplinary working groups and cross-sectoral disease management guidelines tjhrough to the implementation of qualification measures.

[Health economic impact of heart failure: An analysis of the nationwide German database]. / Gesundheitsökonomische Bedeutung der Herzinsuffizienz: Analyse bundesweiter Daten.

BACKGROUND AND AIMS: Patients with congestive heart failure represent a significant amount of the total annual cost of the health care system. Because of a lack of studies on the economic health cost of the related health care, including all cost generating factors, we analysed in detail characteristics of these patients and the costs created by their care. METHOD: Data were retrieved from the German Bureau of Health Statistics for the year 2002 relating to congestive heart failure (Code I50) including other factors (e. g. co-morbidities, ambulatory and hospital care and choice of the doctor). The data were from more than 2 million patients, from 350 insurance companies, the Federal Employees Insurance and the German Institute for Medical Informatics and Documentation. A total of 86 193 patients with congestive heart failure had been recorded. RESULTS: More women than men were recorded as having congestive heart failure (66 vs. 34 %). The various health insurance companies paid 2.3 times more for patients with than without congestive heart failure. Nearly three quarters of the cost for these patients (72 %) resulted from in-patient care. Moreover, costs for drugs were three times higher (1073 Euro vs. 366 Euro). CONCLUSIONS: This analysis clearly demonstrates the increased costs incurred for patients with congestive heart failure. It should serve as a reference base for better assessing future innovations, such as telemedicine, for their effects in different sectors of health care.

[Pacemaker and implantable defibrillators with telemedical support]. / Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung.

Recent developments in pacemaker and ICD therapy can be characterized by a rising number of implantations (especially in the field of ICD and CRT systems) and an increasing complexity of the units involved. Problems evolving from this trend are the soaring numbers of necessary follow-up examinations, issues of patient safety and the necessity of device management by specialized physicians. Telemonitoring offers various possibilities of improvement in these areas. The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with pacemakers, ICD and CRT systems. The systems commonly include an implant capable of either automatic or manual data transmission, a device for transmitting the implant's data (mobile communication or fixed line network), a server managing the information and a front-end (internet-based) platform for the physician. Multiple clinical trials have verified the stability and the security of this method of data transmission. Telemedical monitoring can be used in order to improve the monitoring of the patients' state of health (e. g., patients with CRT systems because of their CHF) and the management of arrhythmias (e. g., patients suffering from paroxysmal atrial fibrillation). Telemonitoring allows the intervals between follow-up check-ups to be individualized, thus, leading to financial savings. The telemedical monitoring of patients with ICD and CRT systems facilitates new opportunities for networked follow-up care and comprehensive medical treatment.