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3. KOLLOQUIA Triesen 2024
(2024)
3. KOLLOQUIA Triesen 2024
(2024)
Bei der «KOLLOQUIA Triesen» handelt es sich um eine öffentliche, interdisziplinäre Tagung zur Wissenschaftstheorie in den Sozialwissenschaften, die seit 2022 jährlich Ende November stattfindet. Zielgruppe der Tagung sind Vertreterinnen und Vertreter sämtlicher sozialwissenschaftlicher Disziplinen, insbesondere der Rechtswissenschaft, der Ökonomik, der Politologie, der Soziologie, der Geschichtswissenschaft und der Philosophie bzw. der allgemeinen Wissenschaftstheorie. Die Tagung soll dazu dienen, sowohl etablierten Experten und Expertinnen als auch jungen Wissenschaftlern und Wissenschaftlerinnen die Möglichkeit zu bieten, ihre Arbeit und Ideen vorzustellen und mit einem Fachpublikum zu diskutieren.
462-P: Medication Documentation in Patients with Type 2 Diabetes Undergoing Coronary Angiography
(2024)
The utilization of multiple medications and the increasing complexity of medication regimens associated with chronic diseases such as type 2 diabetes (T2DM) necessitate the implementation of a medication documentation (MD). A complete medication plan serves to enhance medication safety and promotes adherence. The availability of MD in the clinically important population of T2DM patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD) remains unknown and is addressed in the present study. We analyzed MD, current medication status, and the Medication Regimen Complexity Index (MRCI) in 515 consecutive patients who underwent coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD). Our cohort included 177 patients (34%) with T2DM and 338 patients (66%) without diabetes. Patients with T2DM compared to those without diabetes had a significantly higher number of medications (7 [5-9] vs. 5 [3-6]; p<0.001) and a significantly higher complexity in medication regimens (17 [11-24] vs. 12 [7-16]; p<0.001). Specifically, out of 104 (59%) T2DM patients, MD was available, while 73 (41%) lacked MD. Further classification showed the following categories of MD in patients with diabetes: unstructured documentation in 28 (27%), physician’s letter in 17 (16%), medication plan in 58 (56%) and other categories in 1 (1%). We conclude that patients with T2DM who undergo coronary angiography for the evaluation of established or suspected stable CAD are affected by a high medication complexity and polypharmacy, which highlights the importance of an accurate MD in these patients. However, proper MD is not available in almost half of these patients.
Disclosure
P. Elsner: None. M. Ratz: None. J. Vogel: None. C.H. Saely: None. T. Plattner: None. A. Mader: None. B. Larcher: None. A. Vonbank: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.
<b<iBackground:</i</b Gerbich-negative phenotypes of the Gerbich Blood Group System (ISBT 020) are very rare (with the exception of Papua New Guinea). The Gerbich-negative phenotypes Yus and Gerbich are negative for the antigens Ge2, and Ge2 and Ge3, respectively. In antigen-negative individuals, anti-Ge2 and anti-Ge3 antibodies can be naturally occurring, or are triggered during pregnancies and after transfusions. Previous studies suggested an elevated frequency of Gerbich-negative phenotypes for the Middle East. In the summer of 2015, a large-scale migration of people from the Middle East to Europe occurred raising the issue of question how to guarantee blood supply for patients and manage antenatal care for pregnant women from these countries. <b<iMaterials and Methods:</i</b To investigate the frequency of rare Gerbich-negative phenotypes, 1,665 immigrants to Germany originating from the Middle East were genetically tested for the presence of rare Yus, i.e., <iGE</i*<i01</i.<i-02</i, and Gerbich, i.e., <iGE</i*<i01-03</i, alleles and compared to results obtained from 507 Germans. <b<iResults:</i</b Seven Yus <iGE</i*<i01.-02.01</i and one Gerbich <iGE</i*<i01.-03.02</i alleles were exclusively observed among people from the Middle East, with five of them clustering among 797 Syrians. No such alleles were observed in Germans. A cumulative Yus- and <iGE</i*<i01.-03-</itype allele frequency of 0.00314 and resultant overall Gerbich-negative phenotype frequency of one among 101,633 Syrians were calculated. <b<iConclusion:</i</b This manuscript describes for the first time an exclusively genetic screening for carriers of Gerbich-negative alleles. In conclusion, the Gerbich blood group system should be considered as one causative agent of unusual antibodies to red cell antigens, in routine patients and pregnant women, especially when originating from the Middle East.
Chronic medical conditions such as type 2 diabetes (T2DM) or coronary artery disease (CAD) and their treatment have a crucial impact on patients’ daily life. The EQ-5D-5L questionnaire is a validated and widely used tool to measure the health-related quality of life (HRQL). We investigated and compared the HRQL in patients with or without T2DM and CAD. We included 481 consecutive patients undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in Central Europe. Patients’ HRQL was measured using the EQ-5D-5L, comprising the EQ index calculated from the domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. A response rate of 88.1% was achieved. From our patients, 166 (34.5%) had T2DM according to ADA criteria, and 254 (52.8%) had significant CAD with stenoses ≥50% at angiography. Patients with T2DM showed significantly lower EQ index values than patients without T2DM (0.891 [IQR=0.783-0.970]) vs. 0.943, [IQR=0.861-1.0], p=0.002)). Regarding the different dimensions of the questionnaire, patients with T2DM reported to have significantly more problems with anxiety and depression (p=0.002) and mobility (p&lt;0.001) than nondiabetic patients. EQ index values in contrast did not differ significantly between patients with vs. those without significant CAD. Accordingly, in analysis of covariance T2DM (F=7.38, p=0.007) but not significant CAD (F=1.74, p=0.183) predicted EQ index values after adjustment for age, sex and body-mass-index. We conclude that T2DM rather than the presence of significant CAD is associated with quality of life in angiographied coronary patients.
Disclosure
M. Ratz: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
567-P: Health Literacy in Men and in Women with Type 2 Diabetes Undergoing Coronary Angiography
(2024)
Health literacy reflects the ability to make appropriate health decisions and affects health outcomes. It therefore is an important parameter in patient care and for health care providers. Health literacy in patients undergoing coronary angiography, the standard procedure for the definite evaluation of coronary artery disease (CAD) is unclear and is addressed in the present study. We recruited 515 consecutive patients (383 men and 132 women) undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in central Europe. Health literacy was measured using the validated HLS-EU-Q16 questionnaire. A response rate of 80.4% was achieved. Overall, 177 patients (i.e. 34.3% of the cohort) had type 2 diabetes (T2DM); the prevalence of T2DM was 36.8% in men and in 27.3% in women (p=0.047). Comparing T2DM patients to those who did not have diabetes, overall median health literacy scores (HLS) were 13 [IQR=11-15] vs. 13 [IQR=10-15] among men (p=0.424) and 12 [IQR=10-15] vs. 13 [IQR=10.25-15] among women (p=0.517). Prevalence rates of adequate (HLS 13-16), problematic (HLS 9-12) and inadequate (HLS 0-8) health literacy did not differ significantly between patients with T2DM vs. subjects without T2DM (53.0% vs. 55.4%, 34.8% vs. 29.9% and 12.2% vs. 14.7% among men and 37.5% vs. 55.6%, 45.8% vs. 31.9% and 16.7% vs. 12.5% among women, respectively. We conclude that among patients undergoing coronary angiography for the evaluation of established or suspected stable CAD, health literacy regardless of sex is suboptimal both in patients with T2DM and in nondiabetic subjects.
Disclosure
M. Ratz: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
Lipid-lowering therapy (LLT) is key to reducing the burden of macrovascular diabetes complications. Here, we aim to assess long-term trends in LLT and LDL-C levels among patients with type 2 diabetes (T2DM) with angiographically proven coronary artery disease (CAD). We investigated T2DM patients (n=590), who were referred to elective coronary angiography and were diagnosed with CAD in one of three observational cohort studies (OS) spanning 25 years: OS1: 1999-2000 (n=190); OS2: 2005-2008 (n=241); OS3: 2022-2023 (n=159). These studies were conducted at the same cardiology unit of a tertiary care hospital in Central Europe. The proportion of patients receiving statin therapy (C10AA and C10AB) increased significantly from 57.9% in OS1 to 64.3% in OS2 and 78.6% in OS3 (ptrend&lt;0.001). Further, there was an increase in patients receiving high-intensity statin therapy, rising from none in OS1 to 8.5% in OS2 and 73.4% in OS3 (ptrend&lt;0.001). The proportion of patients receiving more than one LLT compound also increased (OS1: 2.1%; OS2: 2.1%; OS3: 35.2%; ptrend&lt;0.001). Use of ezetimibe (C10AX09) increased (OS1: 0.0%; OS2: 1.2%; OS3: 39.0%; ptrend&lt;0.001) and fibrate use (C10AB) decreased (OS1: 5.3%; OS2: 3.3%; OS3: 0.6%; ptrend=0.015). Newly approved compounds (C10AX13 - C10AX16) were prescribed for 3.8% of patients in OS3. Among statin combination therapies, ezetimibe was predominantly used (93.5%). Mean LDL-C levels declined significantly from 123±38 mg/dL (OS1) to 115±39 mg/dL (OS2) and 77±38 mg/dL (OS3; ptrend&lt;0.001). However, only 2.2% of patients in OS1, 2.5% in OS2 and 32.1% in OS3 reached an LDL-C target of &lt;55 mg/dL (ptrend&lt;0.001). This analysis suggests an upward trend in treatment intensity and a substantial improvement in LDL-C levels among T2DM patients with CAD. However, the majority of these patients still does not reach their LDL-C target.
Disclosure
J. Vogel: None. M. Ratz: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
Satisfaction with information regarding pharmaceutic therapy is important because it may strongly affect the appropriate use of drug therapy including medication adherence. Data on this parameter in the clinically important population of patients with type 2 diabetes (T2DM) undergoing coronary angiography is scarce and is therefore addressed in the present study. We consecutively enrolled a cohort of 515 patients (383 men and 132 women) who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease. Satisfaction with information regarding pharmaceutic therapy was measured using the validated Satisfaction with Information about Medicines Scale (SIMS-D) which consists of two sub-scales covering action and usage (questions 1-9) or potential problems (questions 10-17), respectively. Further, health literacy, which includes the ability to understand and follow instructions for treatment was determined using the EU-HLS-Q16 questionnaire. For SIMS-D a response rate of 68.4% (n=353, 280 men and 73 women) was achieved. From our patients, 124 (36.4% of males and 30.1% of females) had T2DM according to ADA criteria. SIMS-D scores did not differ significantly between T2DM patients and those who did not have diabetes among men 11.5 [IQR=6-16] vs. 9 [IQR=6-15] p=0.121, nor among women 10 [IQR=5.5-12.25] vs. 10 [IQR=5-17] p=0.537. Independent of gender and diabetes status patients scored significantly lower on items targeting satisfaction with information about potential problems of medication than the in sub-scale for action and usage (p&lt;0.001). In analysis of covariance, health literacy independently of T2DM, gender and age predicted SIMS-D (F=41.3; p&lt;0.001). From our findings we conclude that satisfaction with information about medicines in angiographied coronary patients does not depend on the presence of T2DM or gender but is significantly impacted by health literacy.
Disclosure
J. Vogel: None. M. Ratz: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
Introduction:
Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM). Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD).
Hypothesis:
We hypothesize that cardiovasculr risk compares between PAD and CAD when analyses are stratified by the presence of CKD.
Methods:
We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106), CAD patients with CKD (CAD/CKD+; n=250), PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66).
Results:
The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p<0.001), in PAD/CKD- patients (40.9%; p<0.001), and in PAD/CKD+ patients (56.9%; p<0.001), who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p<0.001, respectively). The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063). In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p<0.001), CKD (HR=1.85 [1.51- 2.26]; p<0.001) and T2DM (HR=1.53 [1.29-1.83; p<0.001) were mutually independent predictors of MACE.
Conclusions:
We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.
Posterpreis
(2023)
AbstractSwallowing and cough are crucial components of airway protection. In patients with neurogenic dysphagia (ND), there is a high prevalence of dystussia (impaired cough) and atussia (absence of cough). As a result, the ability to detect and remove aspirated material from the airway decreases, exacerbating the sequelae associated with ND, including aspiration pneumonia, a leading cause of mortality in ND. This controlled intervention study aimed to quantify the cough response to aerosolized capsaicin (AC) in patients with ND and assess the potential of AC as a therapeutic tool in treating ND-related dystussia and atussia. Furthermore, we propose a novel application method that enables AC treatment to be performed at home. Spirometry was used to measure peak cough flow (PCF) of voluntary cough (cough on command) and reflexive cough (cough secondary to pharyngeal exposure to AC) in 30 subjects with and 30 without ND. The capsaicin aerosol was generated by adding 1–10 drops of liquid cayenne extract (1.5–2% capsaicin) to 100 mL carbonated water (0.00075–0.001% to 0.0075–0.01% capsaicin). Voluntary PCF in the ND group was significantly lower than in the control group (p < 0.001), while there was no significant difference in reflexive PCF (p = 0.225). Within the ND group, reflexive PCF was significantly higher than voluntary PCF (p = 0.001), while in healthy controls, reflexive PCF was significantly lower (p < 0.001). The data show that AC increased the tracheobronchial clearance efficacy in ND patients with dystussia and atussia, as it enabled subjects to access their individual cough potential, which is present, but inaccessible, due to neurological disorder.
AbstractBackgroundMillions of people have now been vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, it is still unclear which antibody levels provide protection against mortality. It is further unknown whether measuring antibody concentrations on hospital admission allows for identifying patients with a high risk of mortality.ObjectivesTo evaluate whether anti‐SARS‐CoV2‐spike antibodies on hospital admission predict in‐hospital mortality in patients with coronavirus disease 2019.MethodsWe conducted a prospective, multicentre cohort study on 1152 hospitalized patients who tested positive for SARS‐CoV‐2 with a polymerase chain reaction–based assay. Patients were classified by vaccination status. Anti‐SARS‐CoV‐2 spike antibodies were determined on hospital admission. The investigated end point was in‐hospital mortality for any cause.ResultsSpike antibodies on hospital admission were significantly lower in non‐survivors in both non‐vaccinated (73 U/ml, 95%CI 0–164 vs. 175 U/ml, 95%CI 124–235, p = 0.002) and vaccinated patients (1056 U/ml, 95%CI 701–1411 vs. 1668 U/ml, 95%CI 1580–1757, p < 0.001). Further, spike antibodies were significantly lower in fully vaccinated and boostered patients who died compared to those who survived (mean 883 U/ml, 95%CI 406–1359 vs. 1292 U/ml, 95%CI 1152–1431, p = 0.017 and 1485 U/ml, 95%CI 836–2133 vs. 2050 U/ml, 95%CI 1952–2149, p = 0.036). Patients infected with the currently prevailing Omicron variant were three times more likely to die if spike antibodies were <1200 U/ml (OR 3.458, 95%CI 1.562–7.656, p = 0.001). After adjusting for potential confounders, this value increased to an aOR of 4.079 (95%CI 1.809–9.198, p < 0.001).ConclusionAnti‐SARS‐CoV2 spike‐antibody levels on hospital admission are inversely associated with in‐hospital mortality. Hospitalized patients with lower antibody levels have a higher risk of mortality.
