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Han X, Liu X, Zhong F, Wang Y, Guan H, Zhang Q. Comparison of efficacy and safety of complementary and alternative therapies for coronary heart disease complicated with anxiety or depression disorder: A protocol for Bayesian network meta-analysis. Medicine (Baltimore) 2021; 100:e25084. [PMID: 33761669 PMCID: PMC9282060 DOI: 10.1097/md.0000000000025084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND With the acceleration of the pace of life, the phenomenon of anxiety and depression in patients with coronary heart disease (CHD) is more and more common, and "psycho-cardiology" arises spontaneously. At present, the drug treatments of psycho-cardiology are difficult to achieve satisfactory results, and the side effects are obvious. Complementary and replacement therapies of CHD complicated with anxiety or depression disorder play an increasingly positive role, but there is a lack of comparison among different complementary and alternative therapies. In this study, Bayesian network meta-analysis (NMA) analysis method will be used for the first time to synthesize all the evidences of direct and indirect comparison among a variety of interventions, and rank their effectiveness and safety. METHODS Two independent researchers will search from the beginning to January 2021 mainly including randomized controlled trials (RCTs) and closely related ongoing RCTs of complementary and alternative therapies for CHD complicated with anxiety or depression disorder. And then identify, select and extract the data. The primary outcome measures are frequency of acute attack angina, severity of angina pectoris; the changed score in the validated scales, which can assess severity of anxiety or depression. Secondary outcomes include total efficacy rate, electrocardiogram improvement, traditional Chinese medicine symptoms score, changes of dosage of nitroglycerin and adverse effects. Using softwares WinBUGS 1.4.3 and STATA 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidences will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation. RESULTS This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in the treatment of CHD complicated with anxiety or depression disorder. CONCLUSION Supplementary and replacement therapies play an essential role in improving CHD complicated with anxiety or depression disorder. We expect that the NMA will provide reliable evidences of evidence-based medicine for treatment of CHD complicated with anxiety or depression disorder. PROTOCOL REGISTRATION NUMBER INPLASY202120046. ETHICAL APPROVAL This review does not require ethical approval.
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Affiliation(s)
- Xueyan Han
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province
| | - Xinxin Liu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province
| | - Fengxing Zhong
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing
| | - Yiguo Wang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing
| | - Hui Guan
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province
| | - Qiming Zhang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Lindner R. [Gerontopsychosomatic consultation/liaison service in inpatient acute geriatrics : Effects of trust and support on patient-nurse interaction]. Z Gerontol Geriatr 2018; 51:404-410. [PMID: 29671085 DOI: 10.1007/s00391-018-1393-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geriatric and psychosomatic medicine follow a biopsychosocial paradigm. Despite this similar "Menschenbild" in general, collaboration between geriatrics and psychosomatics is still rare. OBJECTIVES This comparative interventional study aims to find possible effects of psychosomatic work in geriatrics on the interaction between patients and nursing staff and contentment of patients with treatment in general. MATERIAL AND METHODS In the period of one year 238 geriatric patients (return rate 22.2%) of the intervention ward (psychosomatic consultation-/liaison service) and the control ward (TAU) were investigated with an anonymized questionnaire. Two questions were evaluated, concerning the patients trust in the nurses and their experience of being able to speak with them about their anxieties and concerns. This is interpreted as an indicator for the advancement of patients' contentment with treatment. RESULTS In comparison with the control ward during the intervention the answers to both questions showed an increasing trust in the nurses and an increasing experience of speaking about anxieties and concerns with the nurses. This is evaluated as some evidence for the promotion of the patients' contentment with the treatment CONCLUSION: A psychosomatic consultation-/liaison service in geriatric medicine generates a positive effect on the relationship between patients and nursing staff, especially concerning trust and acceptance in existential situations of illness and limitation in hospital.
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Affiliation(s)
- Reinhard Lindner
- Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung, Universität Hamburg, Hamburg, Deutschland. .,Fachbereich Humanwissenschaften, Institut für Sozialwesen, FG Theorie, Empirie und Methoden der Sozialen Therapie, Universität Kassel, Arnold-Bode-Str. 10, 34127, Kassel, Deutschland.
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5
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Fuchs-Strizek R, Berger T. Psychokardiologie in der stationären Rehabilitation. Wien Med Wochenschr 2018; 168:31-38. [DOI: 10.1007/s10354-017-0606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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6
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Von Herzen. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Albus C, Barkhausen J, Fleck E, Haasenritter J, Lindner O, Silber, S. The Diagnosis of Chronic Coronary Heart Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:712-719. [PMID: 29122104 PMCID: PMC5686296 DOI: 10.3238/arztebl.2017.0712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 03/29/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation. METHODS Updated recommendations for the diagnostic evaluation of chronic CHD were developed on the basis of existing guidelines and a systematic literature review and approved by a formal consensus process. RESULTS 8-11% of patients with chest pain who present to a general practitioner and 20-25% of those who present to a cardiologist have chronic CHD. General practitioners should estimate the probability of CHD with the Marburg Heart Score. Specialists can use detailed tables for determining the pre-test probability of CHD; if this lies in the range of 15% to 85%, then non-invasive tests should be primarily used for evaluation and treatment planning. If the pretest probability is less than 15%, other potential causes should be ruled out first. If it is over 85%, the presence of CHD should be presumed and treatment planning should be initiated. Coronary angiography is needed only if therapeutic implications are expected (revascularization). Psychosocial risk factors for the development and course of CHD and the patient's quality of life should be regularly assessed as well. CONCLUSION Non-invasive testing and invasive coronary angiography should be used only if their findings are expected to have therapeutic implications. Psychosocial risk factors, the quality of life, and adherence to treatment are important components of these patients' diagnostic evaluation and long-term care.
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Affiliation(s)
- Christian Albus
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, Schleswig-Holstein University Hospital (UK-SH), Campus Lübeck, Lübeck, Germany
| | - Eckart Fleck
- Internal Medicine/Cardiology, German Society of Cardiology (DGK), DGK Capital Office, Berlin, Germany
| | - Jörg Haasenritter
- Philipps University Marburg, Department of General Medicine, Preventive and Rehabilitative Medicine, Marburg, Germany M. Sc. N., Dipl. Pflegewirt (FH)
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Fangauf SV, Herrmann-Lingen C, Herbeck Belnap B. Ganzheitliche Langzeitbehandlung bei koronarer Herzkrankheit durch Team Care. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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9
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Werdan K. [National disease management guidelines (NVL) for chronic CAD : What is new, what is particularly important?]. Herz 2016; 41:537-60. [PMID: 27586137 DOI: 10.1007/s00059-016-4474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary heart disease (CAD) is widespread and affects 1 in 10 of the population in the age group 40-79 years in Germany. The German national management guidelines on chronic CAD comprise evidence and expert-based recommendations for the diagnostics of chronic stable CAD as well as for interdisciplinary/multidisciplinary therapy and care of patients with stable CAD. The focus is on the diagnostics, prevention, medication therapy, revascularization, rehabilitation, general practitioner care and coordination of care. Recommendations for optimizing cooperation between all medical specialties involved as well as the definition of mandatory and appropriate measures are essential aims of the guidelines both to improve the quality of care and to strengthen the position of the patient.
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Affiliation(s)
- K Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
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10
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Kunschitz E, Friedrich O, Schöppl C, Weiss TW, Miehsler W, Sipötz J, Moser G. Assessment of the need for psychosomatic care in patients with suspected cardiac disease. Wien Klin Wochenschr 2016; 129:225-232. [PMID: 27495803 DOI: 10.1007/s00508-016-1050-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study aimed to assess the subjectively perceived need for additional general disease-oriented and psychotherapeutic care in patients with suspected cardiac disease and to investigate if the request for additional care is consistent with impairment of generic quality of life and the presence of psychosomatic risk factors. MATERIAL AND METHODS Patients referred for cardiac stress testing because of suspected cardiac disease completed the assessment of the demand for additional psychological treatment (ADAPT) questionnaire, an assessment tool for counselling demand in patients with chronic illness, the SF-36 quality of life and the hospital anxiety and depression scale (HADS) questionnaires. RESULTS The questionnaires were administered to 233 patients (age: 54.5 ± 13.4, 57.5 % male). Exclusive demand for disease-oriented counselling was indicated by 45.1 %, demand for psychotherapeutic counselling (exclusive or combined with disease-oriented demand) by 33.9 %. Almost all patients with psychotherapeutic demand (96.3 %) expressed also request for disease-oriented counselling. Patients with exclusive demand for disease-oriented counselling showed significantly lower scores in the emotional and physical functioning and role domains of the SF-36 than the norm population. Patients demanding psychotherapeutic counselling reported significantly lower scores in all SF-36 domains than the norm population. Psychotherapeutic demand was strongly associated with positive indicators for mental distress: SF-36 MH (OR: 4.1), SF-36 MCS (OR: 5.9), HADS anxiety (OR: 3.9), and HADS depression (OR: 3.0). CONCLUSIONS Our study shows that the patients' request for additional care reflects impairment of generic health status and psychological risk load. This indicates that the assessment of subjectively perceived demand allows to screen for patients who are in need of psychosomatic care and motivated to participate in additional counselling and therapy.
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Affiliation(s)
- Evelyn Kunschitz
- II. Medical Department, Cardiology, Hanusch Krankenhaus, Vienna, Austria. .,Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria.
| | - Oliver Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
| | - Christine Schöppl
- II. Medical Department, Cardiology, Hanusch Krankenhaus, Vienna, Austria
| | - Thomas W Weiss
- III. Medical Department, Cardiology, Wilhelminenspital, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Wolfgang Miehsler
- Department of Internal Medicine, Hospital of the Brothers of St. John of God, Salzburg, Austria
| | - Johann Sipötz
- II. Medical Department, Cardiology, Hanusch Krankenhaus, Vienna, Austria.,Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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13
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[Risk factor management of coronary heart disease : what is evidence-based?]. Herz 2014; 39:483-94. [PMID: 24894947 DOI: 10.1007/s00059-014-4108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with coronary heart disease the further course of the disease can be substantially influenced by means of a targeted treatment of risk factors. A reduction of hospital referrals, an improvement in quality of life and an extension in life expectation by secondary prophylactic measures have been well documented. In addition to an optimized medicinal therapy, an often drastic change in lifestyle with a focus on a consistent abstinence from nicotine, a healthy diet and regular physical exercise is necessary. Data from healthcare research show that these targets are only insufficiently achieved. The implementation of current guidelines should therefore be rigorously applied. There is a need for research particularly with respect to the prognostic significance of beta blocker therapy for patients with stable coronary heart disease and preserved left ventricular function, the prognostic significance of targeted weight loss for overweight or obese coronary heart disease patients, the effectiveness of psychosocial interventions in the various patient groups and their implementation into routine care. Research is also necessary with respect to optimization of structured rehabilitation programs and improvement in patient compliance.
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Rother C. [Administration of Cardiodoron® in patients with functional cardiovascular disorders and/or sleep disorders--results of a prospective, non-interventional study]. FORSCHENDE KOMPLEMENTARMEDIZIN (2006) 2013; 20:334-44. [PMID: 24200823 DOI: 10.1159/000355255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functional cardiovascular disorders (FCD) can be attributed to around 25-40% of all heart patients, i.e. organic causes are not detectable. Characteristic symptoms are tachycardia, palpitations, cardiac arrhythmia, hyperventilation, vertigo, vasovagal syncopes and sleep disorders, with the latter being a problem of its own. Disturbed vegetative rhythms form the basis of these diseases. The medicinal product Cardiodoron counteracts the dysfunctional vegetative rhythmicity with 3 medicinal plants--Primula veris (common cowslip), Hyoscyamus niger (black henbane) and Onopordum acanthium (cotton thistle). PATIENTS AND METHODS By means of a prospective, multicentre, non-interventional study, the development of disease-specific disorders during treatment with Cardiodoron (drops) was supposed to be shown. Between September 2009 and March 2012, 92 physicians documented 501 patients suffering from functional cardiovascular and/or sleep disorders who have been treated with Cardiodoron for 3-6 months. After an initial examination, a final examination after 90 (± 10) days and, in case of continuation of therapy, a follow-up examination after 90 (± 10) days were carried out. Besides 30 symptoms assessed by the physicians, the patients rated their condition on the basis of the complaints list according to v. Zerssen (B-L and B-L') and the Pittsburgh Sleep Quality Index (PSQI) according to Buysse. RESULTS The severity of functional cardiovascular disorders as well as sleep disorders was significantly reduced. The same applies for all of the documented 30 disease-specific symptoms. Furthermore, the total score of the complaints list was significantly reduced as well as the PSQI. The largest effect regarding all parameters was detectable after 3 months. Continuation of Cardiodoron therapy stabilised the symptomatology once more and resulted in further improvement. On average, patients reported initial improvement after 13 days of treatment. Tolerability was almost consistently assessed with 'very good / good'. Accordingly, the acceptance of the preparation by the patients was good, which resulted in a very good compliance of 70%. 52% of the patients used additional therapies. CONCLUSIONS Cardiodoron shows positive effects in medical practice; it is a well-tolerated medicinal product for treatment of functional cardiovascular and/or sleep disorders with or without concomitant therapies.
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Affiliation(s)
- Claudia Rother
- WELEDA AG, Klinische Forschung, Schwäbisch Gmünd, Deutschland
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LANG SASKIA, BECKER RÜDIGER, WILKE STEFANIE, HARTMANN MECHTHILD, HERZOG WOLFGANG, LÖWE BERND. Anxiety Disorders in Patients with Implantable Cardioverter Defibrillators: Frequency, Course, Predictors, and Patients’ Requests for Treatment. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:35-47. [DOI: 10.1111/pace.12276] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/24/2013] [Accepted: 08/12/2013] [Indexed: 12/31/2022]
Affiliation(s)
- SASKIA LANG
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - RÜDIGER BECKER
- Department of Cardiology; University of Heidelberg; Heidelberg Germany
| | - STEFANIE WILKE
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - MECHTHILD HARTMANN
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - WOLFGANG HERZOG
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - BERND LÖWE
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek; Hamburg Germany
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