1
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Stempfel S, Aeschbacher S, Blum S, Meyre P, Gugganig R, Beer JH, Kobza R, Kühne M, Moschovitis G, Menghini G, Novak J, Osswald S, Rodondi N, Moutzouri E, Schwenkglenks M, Witassek F, Conen D, Sticherling C. Symptoms and quality of life in patients with coexistent atrial fibrillation and atrial flutter. Int J Cardiol Heart Vasc 2020; 29:100556. [PMID: 32577496 PMCID: PMC7303549 DOI: 10.1016/j.ijcha.2020.100556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
Aims Atrial fibrillation (AF) and atrial flutter (AFL) are two of the most common atrial arrhythmias and often coexist. Many patients with AF or AFL are symptomatic, which impacts their quality of life (QoL). The purpose of this study was to determine whether coexistent AFL represents an added burden for AF patients. Methods We combined baseline data from two large prospective, observational, multicenter cohort studies (BEAT-AF and Swiss-AF). All 3931 patients included in this analysis had documented AF. We obtained information on comorbidities, medication, and lifestyle factors. All participants had a clinical examination and a resting ECG. Symptom burden and QoL at the baseline examination were compared between patients with and without coexistent AFL using multivariable adjusted regression models. Results Overall, 809 (20.6%) patients had a history of AFL. Patients with coexistent AFL more often had history of heart failure (28% vs 23%, p = 0.01), coronary artery disease (30% vs 26%, p = 0.007), failed therapy with antiarrhythmic drugs (44% vs 29%, p < 0.001), and more often underwent AF-related interventions (36% vs 17%, p < 0.001). They were more often symptomatic (70% vs 66%, p = 0.04) and effort intolerant (OR: 1.14; 95% CI: 1.01-1.28; p = 0.04). Documented AFL on the baseline ECG was associated with more symptoms (OR: 2.30; 95% CI: 1.26-4.20; p = 0.007). Conclusion Our data indicates that patients with coexistent AF and AFL are more often symptomatic and report poorer quality of life compared to patients suffering from AF only.
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Affiliation(s)
- Samuel Stempfel
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Steffen Blum
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Pascal Meyre
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Rebecca Gugganig
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | | | - Gianluca Menghini
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Jan Novak
- Department of Cardiology, Bürgerspital Solothurn, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Fabienne Witassek
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Switzerland.,Cardiology Division, University Hospital Basel, University of Basel, Switzerland
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2
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Gugganig R, Aeschbacher S, Leong DP, Meyre P, Blum S, Coslovsky M, Beer JH, Moschovitis G, Müller D, Anker D, Rodondi N, Stempfel S, Mueller C, Meyer-Zürn C, Kühne M, Conen D, Osswald S. Frailty to predict unplanned hospitalization, stroke, bleeding, and death in atrial fibrillation. European Heart Journal - Quality of Care and Clinical Outcomes 2020; 7:42-51. [DOI: 10.1093/ehjqcco/qcaa002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 01/01/2023]
Abstract
Abstract
Aims
Atrial fibrillation (AF) and frailty are common, and the prevalence is expected to rise further. We aimed to investigate the prevalence of frailty and the ability of a frailty index (FI) to predict unplanned hospitalizations, stroke, bleeding, and death in patients with AF.
Methods and results
Patients with known AF were enrolled in a prospective cohort study in Switzerland. Information on medical history, lifestyle factors, and clinical measurements were obtained. The primary outcome was unplanned hospitalization; secondary outcomes were all-cause mortality, bleeding, and stroke. The FI was measured using a cumulative deficit approach, constructed according to previously published criteria and divided into three groups (non-frail, pre-frail, and frail). The association between frailty and outcomes was assessed using multivariable-adjusted Cox regression models. Of the 2369 included patients, prevalence of pre-frailty and frailty was 60.7% and 10.6%, respectively. Pre-frailty and frailty were associated with a higher risk of unplanned hospitalizations [adjusted hazard ratio (aHR) 1.82, 95% confidence interval (CI) 1.49–2.22; P < 0.001; and aHR 3.59, 95% CI 2.78–4.63, P < 0.001], all-cause mortality (aHR 5.07, 95% CI 2.43–10.59; P < 0.001; and aHR 16.72, 95% CI 7.75–36.05; P < 0.001), and bleeding (aHR 1.53, 95% CI 1.11–2.13; P = 0.01; and aHR 2.46, 95% CI 1.61–3.77; P < 0.001). Frailty, but not pre-frailty, was associated with a higher risk of stroke (aHR 3.29, 95% CI 1.2–8.39; P = 0.01).
Conclusion
Over two-thirds of patients with AF are pre-frail or frail. These patients have a high risk for unplanned hospitalizations and other adverse events. These findings emphasize the need to carefully evaluate these patients. However, whether screening for pre-frailty and frailty and targeted prevention strategies improve outcomes needs to be shown in future studies.
Clinical trial registration
Clinicaltrials.gov identifier number: NCT02105844.
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Affiliation(s)
- Rebecca Gugganig
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton, 237 Barton Street East Hamilton, Ontario, Canada
| | - Pascal Meyre
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Steffen Blum
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Schanzenstrasse 55, 4056 Basel, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Dominic Müller
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Daniela Anker
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010 Bern, Switzerland
| | - Samuel Stempfel
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christine Meyer-Zürn
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, 237 Barton Street East Hamilton, Ontario, Canada
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
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3
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Meyre P, Gugganig R, Aeschbacher S, Leong DP, Blum S, Coslovsky M, Beer JH, Moschovitis G, Mueller D, Rodondi N, Stempfel S, Mueller C, Kuehne M, Conen D, Osswald S. P3782Frailty to predict unplanned hospitalizations, stroke, bleeding and death in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0631] [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: 11/14/2022] Open
Abstract
Abstract
Aim
We investigated the prevalence of frailty, and the relationships between frailty and the risk of adverse clinical outcomes in patients with atrial fibrillation (AF).
Methods
Patients with known AF were enrolled in a nation-wide observational cohort study in Switzerland. Information on medical history, medication, lifestyle factors and clinical measurements were obtained. The primary outcome was unplanned hospitalizations, secondary outcomes were all-cause mortality, bleeding and stroke. The frailty index (FI) was measured using a cumulative deficit approach according to previously published criteria. Participants were divided into three groups (non-frail, pre-frail and frail) according to their FI at study entry. The association between frailty and clinical outcomes was assessed using multivariable adjusted Cox proportional hazard models.
Results
We included 2369 patients with a mean age of 73±8 years (27.3% female). The prevalence of frailty and pre-frailty was 10.6% and 60.7%, respectively. Frailty was associated with unplanned hospitalization (adjusted hazard ratio [HR] 3.59; 95% confidence interval [95% CI], 2.78–4.63; p<0.001), all-cause mortality (adjusted HR 16.72; 95% CI 7.75–36.05; p<0.001), bleeding (adjusted HR 2.46; 95% CI 1.61–3.77; p<0.001), and stroke (adjusted HR 3.29; 95% CI 1.29–8.39; p=0.01) (Figure). Similarly, pre-frailty was significantly associated with unplanned hospitalization (adjusted HR 1.82; 95% CI 1.49–2.22; p<0.001), all-cause mortality (adjusted HR 5.07; 95% CI 2.43–10.59; p<0.001) and bleeding (adjusted HR 1.53; 95% CI 1.11–2.13; p=0.01), but not with stroke.
Cumulative incidence of adverse events
Conclusion
In our cohort, more than two thirds of AF patients were either pre-frail or frail. These patients have a high risk of unplanned hospitalizations and other adverse outcomes, indicating that frailty is a powerful tool to predict adverse clinical outcomes in AF patients.
Acknowledgement/Funding
Swiss National Science Foundation; Foundation for Cardiovascular Research Basel; University of Basel
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Affiliation(s)
- P Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - R Gugganig
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Aeschbacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D P Leong
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - S Blum
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Coslovsky
- University Hospital Basel, Department of Clinical Research, Basel, Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Department of Cardiology, Lugano, Switzerland
| | - D Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - N Rodondi
- Bern University Hospital, Department of General Medicine, Bern, Switzerland
| | - S Stempfel
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
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4
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Conen D, Rodondi N, Müller A, Beer JH, Ammann P, Moschovitis G, Auricchio A, Hayoz D, Kobza R, Shah D, Novak J, Schläpfer J, Di Valentino M, Aeschbacher S, Blum S, Meyre P, Sticherling C, Bonati LH, Ehret G, Moutzouri E, Fischer U, Monsch AU, Stippich C, Wuerfel J, Sinnecker T, Coslovsky M, Schwenkglenks M, Kühne M, Osswald S, Berger S, Bernasconi R, Fröhlich L, Göldi T, Gugganig R, Kofler T, Krisai P, Mongiat M, Pudenz C, Repilado JR, Schweizer A, Springer A, Stempfel S, Szucs T, van der Stouwe J, Voellmin G, Zwimpfer L, Aujesky D, Fuhrer J, Roten L, Jung S, Mattle H, Adam L, Aubert CE, Feller M, Schneider C, Loewe A, Flückiger T, Groen C, Schwab N, Beynon C, Dillier R, Eberli F, Fontana S, Franzini C, Juchli I, Liedtke C, Nadler J, Obst T, Schneider X, Studerus K, Weishaupt D, Kuest S, Scheuch K, Hischier D, Bonetti N, Bello C, Isberg H, Grau A, Villinger J, Papaux MM, Baumgartner P, Filipovic M, Frick M, Anesini A, Camporini C, Conte G, Caputo ML, Regoli F, Moccetti T, Brenner R, Altmann D, Forrer M, Gemperle M, Firmann M, Foucras S, Berte B, Kaeppeli A, Mehmann B, Pfeiffer M, Russi I, Schmidt K, Weberndoerfer V, Young M, Zbinden M, Vicari L, Frangi J, Terrot T, Gallet H, Guillermet E, Lazeyras F, Lovblad KO, Perret P, Teres C, Lauriers N, Méan M, Salzmann S, Arenja N, Grêt A, Vitelli S, Frangi J, Gallino A, Schoenenberger-Berzins R, Witassek F, Radue EW, Benkert P, Fabbro T, Simon P, Schmid R. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 73:989-999. [DOI: 10.1016/j.jacc.2018.12.039] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 01/06/2023]
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5
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Ruperti Repilado FJ, Aeschbacher S, Bossard M, Schoen T, Gugganig R, van der Stouwe JG, Krisai P, Kofler T, Buser A, Risch M, Risch L, Mueller C, Conen D. Relationship of N-Terminal fragment of Pro-B-Type Natriuretic Peptide and copeptin with erythrocytes-related parameters: A population-based study. Clin Biochem 2016; 49:651-656. [PMID: 26851156 DOI: 10.1016/j.clinbiochem.2016.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Plasma levels of natriuretic peptides (NP) have been inversely related to hemoglobin (Hb) concentration in prior studies. However, the mechanism underlying this association remains unclear. We aimed to obtain further insights into potential mechanisms for this correlation in a cohort of healthy adults. METHODS A population-based study was performed among 2113 healthy adults aged 25-41years. Relationships of N-Terminal fragment of Pro-B-Type Natriuretic Peptide (NT-proBNP) or copeptin with volume-dependent (Hb, hematocrit (Hct), erythrocyte count (EC), mean corpuscular Hb concentration (MCHC)) and volume-independent (mean corpuscular volume (MCV), mean corpuscular Hb (MCH)) erythrocyte-related parameters were assessed using sex-specific multivariable linear regression analyses. RESULTS The median age was 36.7years. Median NT-proBNP (ng/L) levels were 49.5 and 20 among women and men, respectively (p<0.0001). Mean (standard deviation) Hb (g/L) levels were 130.1(9.1) and 149.7(8.6) among women and men, respectively (p<0.0001). Among men, multivariable adjusted β-coefficients (95% confidence interval) for NT-proBNP were -1.68 (-2.36; -1.01), p<0.0001 for Hb; -0.38 (-0.57; -0.20), p<0.0001 for Hct; -0.06 (-0.09; -0.04), p<0.0001 for EC; -0.78 (-1.50; -0.07), p=0.03 for MCHC; 0.26 (-0.04; 0.56), p=0.09 for MCV; and 0.03 (-0.08; 0.14), p=0.61 for MCH. For copeptin, these relationships were 1.36 (0.39; 2.32), p=0.006; 0.41 (0.15; 0.68), p=0.002; 0.06 (0.02; 0.09), p=0.002; -0.17 (-1.19; 0.86), p=0.75; -0.12 (-0.55; 0.31), p=0.58 and -0.05 (-0.21; 0.10), p=0.52. Similar results were observed among women. CONCLUSIONS We found significant relationships of NT-proBNP and copeptin with volume-dependent but not volume-independent erythrocyte-related parameters, suggesting that hemodilution may at least in part explain these associations.
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Affiliation(s)
- Francisco Javier Ruperti Repilado
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefanie Aeschbacher
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Matthias Bossard
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Tobias Schoen
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Rebecca Gugganig
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jan Gerrit van der Stouwe
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Krisai
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Thomas Kofler
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Andreas Buser
- Hematology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Martin Risch
- Labormedizinisches Zentrum Dr. Risch, Schaan, FL, Liechtenstein; Division of Laboratory Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Schaan, FL, Liechtenstein; Division of Clinical Biochemistry, Medical University Innsbruck, Innsbruck, Austria; UFL Private University, Fürstentum, Liechtenstein
| | - Christian Mueller
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - David Conen
- Internal Medicine Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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