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Bahrmann P, Kunz AL, Schoenstein A, Giannitsis E, Wahl HW, Katus H, Frey N, Bahrmann A. Exploring biomarkers of age in routine diagnostics for the risk stratification of older patients in the emergency department. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To estimate the association of the routinely applied biological age-related biomarkers hs-TnT, CRP and Hemoglobin (Hb) with mortality for the purpose of older patient's risk stratification in the emergency department (ED).
Design
Exploratory, prospective cohort study with a follow-up at 2.5 years after recruitment start.
Setting and participants
A cardiological emergency department (ED), chest pain unit, of our University Hospital. N=256 cardiological ED patients with a minimum age of 70 years and with an expected life-expectancy above 24h.
Methods
Data from the hospital files were supplemented by a questionnaire. Patients were followed-up for mortality by requesting registry office information.
Results
Among N=256 patients 63 died over the follow-up period. Positive results in each of the three biomarkers alone as well as the combination were associated with increased all-cause mortality at follow-up. The number of positive age-related biomarkers appeared to be strongly indicative of the risk of mortality, even when controlled for major confounders (age, sex, BMI, creatinine clearance, and comorbidity).
Conclusion and implications
In older ED patients, biomarkers explicitly related to biological aging processes such as hs-TnT, CRP and Hb were independently of each other as well as combined associated with an increased risk of all-cause mortality. Thus, they may have the potential to be used to supplement the general risk stratification of older patients in the ED. Validation of the results in a large dataset is needed.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Robert Bosch Foundation, Stuttgart, Germany Kaplan-Meier curves with 95% CIKaplan-Meier curves for patients grouped
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Affiliation(s)
- P Bahrmann
- Friedrich-Alexander-University, Institute for Biomedicine of Aging, Nuremberg, Germany
| | - A L Kunz
- University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - A Schoenstein
- University of Heidelberg, Network Aging Research, Heidelberg, Germany
| | - E Giannitsis
- University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - H.-W Wahl
- University of Heidelberg, Network Aging Research & Institute of Psychology, Heidelberg, Germany
| | - H Katus
- University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - N Frey
- University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - A Bahrmann
- University Hospital of Heidelberg, Department of Cardiology, Heidelberg, Germany
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Pahmeier K, Denkinger M, Seufferlein T, Klaus J, Bauer J, Katus H, Bahrmann A, Geisler T, Muche R, Müller M, Suhr R, Frankenhauser-Mannuß J, Flagmeier AL, Dallmeier D, Leinert C, Wasem J, Biermann-Stallwitz J, Neumann A. Studiendesign – Gesundheitsökonomische Evaluation einer Interventionsstudie zur Delirreduktion (TRADE). Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Pahmeier
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
| | - M Denkinger
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - T Seufferlein
- Universitätsklinikum Ulm, Klinik für Innere Medizin I
| | - J Klaus
- Universitätsklinikum Ulm, Klinik für Innere Medizin I
| | - J Bauer
- AGAPLESION BETHANIEN Krankenhaus Heidelberg, Klinik für Akutgeriatrie
| | - H Katus
- Universitätsklinikum Heidelberg, Klinik für Kardiologie, Angiologie, Pneumologie
| | - A Bahrmann
- Universitätsklinikum Heidelberg, Klinik für Kardiologie, Angiologie, Pneumologie
| | - T Geisler
- Universitätsklinikum Tübingen, Deutsches Herzkompetenzzentrum, Medizinische Klinik III
| | - R Muche
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie
| | - M Müller
- Technische Hochschule Rosenheim, Fakultät für Angewandte Gesundheits- und Sozialwissenschaften
| | - R Suhr
- Zentrum für Qualität in der Pflege
| | | | - AL Flagmeier
- AOK Baden-Württemberg, Rehabilitations- und Pflegeforschung
| | - D Dallmeier
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - C Leinert
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - J Wasem
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
| | | | - A Neumann
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
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Schönstein A, Wahl HW, Katus HA, Bahrmann A. SPMSQ for risk stratification of older patients in the emergency department : An exploratory prospective cohort study. Z Gerontol Geriatr 2019; 52:222-228. [PMID: 31620876 PMCID: PMC6821671 DOI: 10.1007/s00391-019-01626-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/11/2019] [Indexed: 12/26/2022]
Abstract
Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own. Electronic supplementary material The online version of this article (10.1007/s00391-019-01626-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Schönstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany.
| | - H-W Wahl
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - H A Katus
- Heidelberg University Hospital, Heidelberg, Germany
| | - A Bahrmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Heidelberg University Hospital, Heidelberg, Germany
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-113142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Zeyfang
- AGAPLESION Bethesda Krankenhaus Stuttgart
| | - A. Bahrmann
- Universitätsklinikum Heidelberg, Medizinische Klinik III, Heidelberg
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1553883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A. Zeyfang
- AGAPLESION Bethesda Krankenhaus Stuttgart
| | - A. Bahrmann
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen
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Bahrmann A, Wilhelm B, Zeyfang A. Insulin degludec bei speziellen Patientengruppen. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0034-1399266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. Bahrmann
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany
| | - B. Wilhelm
- Clinical, Medical & Regulatory Department, Novo Nordisk Pharma GmbH, Mainz, Germany
| | - A. Zeyfang
- Innere Medizin, AGAPLESION Bethesda Krankenhaus, Stuttgart, Germany
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0034-1385401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. Zeyfang
- AGAPLESION Bethesda Krankenhaus Stuttgart
| | - A. Bahrmann
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen
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Bahrmann A, Wörz E, Specht-Leible N, Oster P, Bahrmann P. [Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study]. Z Gerontol Geriatr 2014; 48:246-54. [PMID: 24740530 DOI: 10.1007/s00391-014-0626-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. METHODS In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. RESULTS Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). CONCLUSION Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.
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Affiliation(s)
- A Bahrmann
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland,
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Zeyfang A, Bahrmann A, Wernecke J. Erratum:Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1356350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1356098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Zeyfang
- AGAPLESION Bethesda Krankenhaus Stuttgart
| | - A. Bahrmann
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen
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Bahrmann P, Christ M, Bahrmann A, Rittger H, Heppner HJ, Achenbach S, Bertsch T, Sieber CC. Fast-track high-sensitive cardiac troponin T algorithm for diagnosis of non-ST-elevation myocardial infarction in older patients at the emergency department. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bahrmann P, Bertsch T, Bahrmann A, Christ M, Achenbach S, Sieber CC. Mid-regional atrial natriuretic peptide and C-terminal pro-endothelin-1 for early diagnosis of acute heart failure in unselected older patients presenting to the emergency department. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zeyfang A, Bahrmann A. [Diabetes in old age--risk by over- and undertreatment]. MMW Fortschr Med 2013; 155:56-58. [PMID: 23964510 DOI: 10.1007/s15006-013-1142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A Zeyfang
- AG Diabetes und Geriatrie der DDG, Stuttgart.
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1325571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Zeyfang
- AGAPLESION Bethesda Krankenhaus Stuttgart
| | - A. Bahrmann
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen
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Bahrmann A, Hölscher E, Hodeck K, Oster P, Daniel WG. Strukturierte Weiterbildung zur Diabetespflegefachkraft - eine prospektive kontrollierte Studie. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bahrmann P, Heppner H, Bahrmann A, Christ M, Bertsch T, Sieber C. Diagnostik des akuten Myokardinfarkts bei älteren Patienten. Z Gerontol Geriatr 2011; 44:166-71. [DOI: 10.1007/s00391-011-0196-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hodeck K, Trept S, Jannaschk KD, Bahrmann A. Diabetes-Schwerpunktpflegedienste sichern die Versorgung geriatrischer Patienten mit Diabetes mellitus. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zeyfang A, Dippel F, Bahrmann A, Bahr R, Feucht I, Hamann O, Hodeck K. Aktuelle Versorgungssituation und Ressourcenbedarf bei insulinpflichtigen Typ-2-Diabetikern in ambulanter und stationärer Pflege: Ergebnisse der LIVE-GERI Studie. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1262591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1262596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bahrmann A, Abel A, Specht-Leible N, Abel A, Wörz E, Hölscher E, Zieschang T, Oster P, Zeyfang A. [Treatment quality in geriatric patients with diabetes mellitus in various home environments]. Z Gerontol Geriatr 2010; 43:386-92. [PMID: 20401505 DOI: 10.1007/s00391-010-0104-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.
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Affiliation(s)
- A Bahrmann
- Bethanien-Krankenhaus, Geriatrisches Zentrum an der Ruprecht-Karls-Universität Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
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