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Gioia G, Schrutka L, Jozwiak-Nozdrzykowska J, Kresoja KP, Gunold H, Klingel K, Thiele H, Bonderman D, Lurz P, Rommel KP. Transthyretin amyloid cardiomyopathy among patients with heart failure and preserved ejection fraction: the AMY score. ESC Heart Fail 2024. [PMID: 38613409 DOI: 10.1002/ehf2.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/03/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
AIMS Transthyretin 'wild-type' amyloid cardiomyopathy (ATTRwt-CM) is a differential diagnosis of heart failure with preserved ejection fraction (HFpEF). The clinical work-up for ATTRwt-CM is challenging. Considering a combination of clinical variables specific for ATTRwt-CM might aid in identifying patients at risk. METHODS AND RESULTS Sixty patients (78 ± 6 years, 8% female) were diagnosed with ATTRwt-CM by endomyocardial biopsy. Preserved ejection fraction (LVEF >45%) was present in 41 of the patients. Those were 1:1 propensity score age- and sex-matched to a cohort of patients with HFpEF. ATTRwt-CM patients had less obesity (P = 0.01) and higher septal thickness (IVSd, P < 0.01) as well as more diastolic dysfunction (E/e', P < 0.01). On multivariable regression IVSd > 14 mm, E/e' > 14 and absence of obesity (P > 0.01 for all) were identified as predictors for ATTRwt-CM. A weighted point-based score was derived with IVSd > 14 mm = 1 point; absence of obesity = 2 points; and E/e' > 14 = 3 points. Area under the curve (AUC) for the summation score was 0.91 (0.84-0.97, P < 0.01) and a score of more than 3 points predicted ATTRwt-CM with good sensitivity (78%) and specificity (90%). The score was validated in an external cohort of 142 patients with ATTRwt-CM and 419 HFpEF patients showing sufficient accuracy (AUC 0.91, 0.88-0.94, P < 0.01). A value greater than 3 points demonstrated a high sensitivity (93%) and a negative predictive value of 97%. CONCLUSIONS A score based on basic clinical and echocardiographic features helps to distinguish ATTRwt-CM from typical HFpEF. This could facilitate the diagnostic work-up for these patients and enable earlier disease screening on a large scale.
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Affiliation(s)
- Guglielmo Gioia
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Lore Schrutka
- Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | | | - Karl-Patrik Kresoja
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Hilka Gunold
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Karin Klingel
- Kardiopathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Holger Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | | | - Philipp Lurz
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
- Cardiovacular Research Foundation, New York, NY, USA
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Eifert S, Cseke L, Schulz U, Jawad K, Feder S, Al-Naamani A, Garbade J, Nozdrzykowski M, Jozwiak-Nozdrzykowska J, Gunold H, Borger M, Saeed D. Treatment Results of LVAD Implantation and Heart Transplantation for Oncotherapy Induced Cardiomyopathy in Women and Men. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1482] [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] Open
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Kitamura M, Kresoja KP, Balata M, Besler C, Rommel KP, Unterhuber M, Lurz J, Rosch S, Gunold H, Noack T, Thiele H, Lurz P. Health Status After Transcatheter Tricuspid Valve Repair in Patients With Functional Tricuspid Regurgitation. JACC Cardiovasc Interv 2021; 14:2545-2556. [PMID: 34887048 DOI: 10.1016/j.jcin.2021.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to investigate changes in quality of life (QoL) after transcatheter tricuspid valve repair (TTVR) for tricuspid regurgitation (TR). BACKGROUND TTVR provides feasible and durable efficacy in reducing TR, but its clinical benefits on QoL still remain unclear. METHODS In 115 subjects undergoing TTVR for severe functional TR, QoL was evaluated using the 36-Item Short Form Health Survey (SF-36) and the Minnesota Living With Heart Failure Questionnaire (MLHFQ). All-cause mortality, heart failure (HF) rehospitalization, and a composite endpoint of all-cause mortality, HF rehospitalization, and repeat TTVR were recorded as clinical events. RESULTS Successful device implantation was achieved in 110 patients (96%). Moderate or less TR at discharge was achieved in 95 patients (83%). Mean SF-36 physical component summary (PCS) score improved from 34 ± 9 to 37 ± 9 points (+3 points; 95% CI: 1-5 points; P = 0.001), mean SF-36 mental component summary score improved from 49 ± 9 to 51 ± 10 points (+2 points; 95% CI: 0-4 points; P = 0.017), and mean MLHFQ score decreased from 29 ± 14 to 20 ± 15 points (-8 points; 95% CI: -11 to -5 points; P < 0.001). Baseline PCS, moderate or less TR at discharge, and baseline massive or torrential TR were associated with 1-month change in PCS score (P < 0.05). Change in PCS score after 1 month predicted HF rehospitalization after TTVR (adjusted HR: 0.74 [95% CI: 0.60-0.92] per 5-point increase in PCS score; P = 0.008). CONCLUSIONS This study demonstrates that TTVR provides improvement in QoL in patients with relevant TR. TR reduction to a moderate or less grade was associated with improvement of SF-36 and MLHFQ scores. Further, global QoL was associated with clinical outcomes and might serve as a future outcome surrogate following TTVR.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mahmoud Balata
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Julia Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sebastian Rosch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hilka Gunold
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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Tersalvi G, Vicenzi M, Kirsch K, Gunold H, Thiele H, Lombardi F, Mangner N, Sandri M. Structured telephone support programs in chronic heart failure may be affected by a learning curve. J Cardiovasc Med (Hagerstown) 2020; 21:231-237. [PMID: 32004244 DOI: 10.2459/jcm.0000000000000934] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-to-care curve on outcome. METHODS We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation. RESULTS At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P = 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P < 0.001). We also observed that the HeartNetCare patients enrolled after 12 months from the initiation of the program had a more favorable outcome in primary endpoint compared with controls. CONCLUSION These results indicate that the long-term impact of a structured telephone support program might be able to positively influence symptoms and reduce events in chronic heart failure. These appreciable effects where more evident after an initial period essential for completing the learning-to-care curve.
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Affiliation(s)
- Gregorio Tersalvi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Katharina Kirsch
- Heart Center Leipzig, University Hospital of Cardiology, Leipzig
| | - Hilka Gunold
- Heart Center Leipzig, University Hospital of Cardiology, Leipzig
| | - Holger Thiele
- Heart Center Leipzig, University Hospital of Cardiology, Leipzig
| | - Federico Lombardi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Norman Mangner
- Department of Internal Medicine/Cardiology, Heart Center Dresden, Technical University of Dresden, Dresden, Germany
| | - Marcus Sandri
- Heart Center Leipzig, University Hospital of Cardiology, Leipzig
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Barthel L, Kroiss M, Sehner S, Lezius S, Gunold H, Edelmann F, Wachter R, Graf T, Pankuweit S, Knappe D, Stork S, Deckert J, Ertl G, Fassnacht M, Angermann CE. P5450Evening levels and circadian changes of salivary cortisol predict adverse events in heart failure patients with comorbid depression - a MOOD-HF substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0406] [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: 11/12/2022] Open
Abstract
Abstract
Background
Depression is frequent in heart failure (HF) and associated with adverse clinical outcomes. The randomized MOOD-HF trial showed that in depressed patients with systolic heart failure (HF) the selective serotonin reuptake inhibitor escitalopram (E) improved neither survival nor depression compared to placebo (P). The hypothalamic-pituitary-adrenocortical axis is known to be altered in depression or HF. This MOOD-HF substudy aimed to clarify whether circadian salivary cortisol levels (SCL) were predictive of adverse events in depressed MOOD-HF participants and whether outcomes differed according to treatment with E.
Methods
MOOD-HF participants (all suffering from symptomatic systolic HF with left ventricular ejection fraction (LVEF) <45% and current major depression) were eligible for the present analysis if providing samples for SCL determination (luminescence immunoassay) at baseline visit (BL) and if not on oral glucocorticosteroid therapy. Depression severity was determined with the Montgomery–Åsberg Depression Rating Scale (MADRS) and LVEF measured by echocardiography.
Results
In the total study cohort (146 patients on E, 147 on P) median morning SCL at BL was 0.210 μg/dL (IQR 0.141–0.338 μg/dL) and median evening (pm) SCL 0.067 μg/dL (0.036–0.128 μg/dL, p<0.001). Median circadian change was 0.124 μg/dL (0.044–0.239 μg/dL). In patients with BL pm-SCL above the median MADRS-score was 21.7±9.1 and LVEF 33.7±8.4% respectively, in patients with pm-SCL below the median these values were 19.6±9.1 and 36.5±7.8% (p=0.048; p=0.004).
During 12 months follow-up the composite endpoint (all-cause death or rehospitalization) occurred least in E-treated patients with low pm-SCL and most often in E-treated patients with high pm-SCL (HR 2.02, 95% CI 1.12–3.65, p=0.010); patients on P had comparable event rates irrespective of BL pm-SCL (Figure A). Thus, numerically patients on E with low BL pm-SCL had lower event rates compared with corresponding P-treated patients (HR 0.76 (0.41–1.40, p=0.796)), while patients with high BL pm-SCL had higher event rates (HR 1.29 (0.74–2.24, p=0.799)) than corresponding P-treated patients. Patients with circadian SCL changes above the median receiving P experienced the composite primary endpoint least, while both subgroups with circadian SCL changes below the median and also patients with circadian SCL changes above the median on E had higher event rates (HR 0.66 (0.45–0.97, p=0.039), Figure B).
Conclusion
In depressed patients with systolic HF high pm-SCL are associated with more severe disease (depression and cardiac dysfunction). Extending primary MOOD-HF results indicating unfavourable outcomes related to E, the current findings suggest a SCL x treatment interaction with higher event rates in (sicker) patients with high pm-SCL and lower event rates in (less sick) patients with low pm-SCL when treated with the antidepressant. Low circadian changes of SCL were always associated with higher event rates.
Acknowledgement/Funding
BMBF (Grant 01 KG0702) and Lundbeck A/S Denmark
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Affiliation(s)
- L Barthel
- University Hospital Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany
| | - M Kroiss
- University Hospital Würzburg, Department of Medicine I, Endocrinology, Würzburg, Germany
| | - S Sehner
- University Medical Center Hamburg Eppendorf, Department of Biometry and Epidemiology, Hamburg, Germany
| | - S Lezius
- University Medical Center Hamburg Eppendorf, Department of Biometry and Epidemiology, Hamburg, Germany
| | - H Gunold
- University Hospital Leipzig, Department of Medicine and Cardiology and Heart Center, Leipzig, Germany
| | - F Edelmann
- University Hospital Berlin, Department of Internal Medicine, Cardiology, Charité – Campus Virchow-Klinikum, Berlin, Germany
| | - R Wachter
- University Hospital Leipzig, Department of Cardiology, Leipzig, Germany
| | - T Graf
- University Hospital Lübeck, Department of Medicine II, Cardiology, Lübeck, Germany
| | - S Pankuweit
- University Hospital Marburg, Department of Cardiology, Marburg, Germany
| | - D Knappe
- University Heart Center Hamburg, Hamburg, Germany
| | - S Stork
- University Hospital Würzburg, Comprehensive Heart Failure Center and Department of Medicine I, Würzburg, Germany
| | - J Deckert
- University Hospital Würzburg, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Center of Mental Health, Würzburg, Germany
| | - G Ertl
- University Hospital Wurzburg, Wurzburg, Germany
| | - M Fassnacht
- University Hospital Würzburg, Department of Medicine I, Endocrinology, Würzburg, Germany
| | - C E Angermann
- University Hospital Würzburg, Comprehensive Heart Failure Center and Department of Medicine I, Würzburg, Germany
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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] [What about the content of this article? (0)] [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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Angermann CE, Gelbrich G, Störk S, Gunold H, Edelmann F, Wachter R, Schunkert H, Graf T, Kindermann I, Haass M, Blankenberg S, Pankuweit S, Prettin C, Gottwik M, Böhm M, Faller H, Deckert J, Ertl G. Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression: The MOOD-HF Randomized Clinical Trial. JAMA 2016; 315:2683-93. [PMID: 27367876 DOI: 10.1001/jama.2016.7635] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Depression is frequent in patients with heart failure and is associated with adverse clinical outcomes. Long-term efficacy and safety of selective serotonin reuptake inhibitors in these patients are unknown. OBJECTIVE To determine whether 24 months of treatment with escitalopram improves mortality, morbidity, and mood in patients with chronic systolic heart failure and depression. DESIGN, SETTING, AND PARTICIPANTS The Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients (MOOD-HF) study was a double-blind, placebo-controlled randomized clinical trial conducted at 16 tertiary medical centers in Germany. Between March 2009 and February 2014, patients at outpatient clinics with New York Heart Association class II-IV heart failure and reduced left ventricular ejection fraction (<45%) were screened for depression using the 9-item Patient Health Questionnaire. Patients with suspected depression were then invited to undergo a Structured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to establish the diagnosis. INTERVENTIONS Patients were randomized 1:1 to receive escitalopram (10-20 mg) or matching placebo in addition to optimal heart failure therapy. Study duration was 24 months. MAIN OUTCOMES AND MEASURES The composite primary outcome was time to all-cause death or hospitalization. Prespecified secondary outcomes included safety and depression severity at 12 weeks of treatment (including the titration period), which were determined using the 10-item Montgomery-Åsberg Depression Rating Scale (total possible score, 0 to 60; higher scores indicate more severe depression). RESULTS A total of 372 patients (mean age, 62 years; 24% female) were randomized and had taken at least 1 dose of study medication when the data and safety monitoring committee recommended the trial be stopped early. During a median participation time of 18.4 months (n = 185) for the escitalopram group and 18.7 months (n = 187) for the placebo group, the primary outcome of death or hospitalization occurred in 116 (63%) patients and 119 (64%) patients, respectively (hazard ratio, 0.99 [95% CI, 0.76 to 1.27]; P = .92). The mean Montgomery-Åsberg Depression Rating Scale sum score changed from 20.2 at baseline to 11.2 at 12 weeks in the escitalopram group and from 21.4 to 12.5 in the placebo group (between-group difference, -0.9 [95% CI,-2.6 to 0.7]; P = .26). Safety parameters were comparable between groups. CONCLUSIONS AND RELEVANCE In patients with chronic heart failure with reduced ejection fraction and depression, 18 months of treatment with escitalopram compared with placebo did not significantly reduce all-cause mortality or hospitalization, and there was no significant improvement in depression. These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN33128015.
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Affiliation(s)
- Christiane E Angermann
- Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Wurzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg and Clinical Trial Center Würzburg, University Hospital Würzburg, Wurzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Wurzburg, Germany
| | - Hilka Gunold
- Department of Medicine and Cardiology and Heart Center, University Hospital Leipzig, Leipzig, Germany
| | - Frank Edelmann
- Department of Cardiology, University Hospital Göttingen, Gottingen, Germany5Department of Internal Medicine, Cardiology, Charité-Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Göttingen, Gottingen, Germany
| | | | - Tobias Graf
- Department of Medicine II, University Hospital Lübeck, Lubeck, Germany
| | - Ingrid Kindermann
- Department of Medicine III, Saarland University Hospital, Homburg (Saar), Germany
| | - Markus Haass
- Department of Cardiology, Theresienkrankenhaus (Academic Teaching Hospital of the University of Heidelberg), Heidelberg, Germany
| | | | - Sabine Pankuweit
- Department of Cardiology, University Hospital Marburg, Marburg, Germany
| | | | - Martin Gottwik
- Department of Cardiology, University Hospital Nürnberg, Klinikum Nürnberg, Nurnberg, Germany
| | - Michael Böhm
- Department of Medicine III, Saarland University Hospital, Homburg (Saar), Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences, Center of Mental Health, University of Würzburg, Wurzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Wurzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Wurzburg, Germany
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Affiliation(s)
- H. Gunold
- Herzzentrum Leipzig, Universität Leipzig, Klinik für Innere Medizin, Leipzig
| | - C. Angermann
- Medizinische Klinik und Poliklinik I, Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg
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Romppel M, Gunold H, Schubmann R, Richter C, Grande G. Nachhaltige Lebensstilmodifikation bei Koronarer Herzkrankheit aus Patientensicht. Phys Rehab Kur Med 2013. [DOI: 10.1055/s-0033-1353143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Romppel
- Fakultät Angewandte Sozialwissenschaften, Hochschule für Technik, Wirtschaft und Kultur Leipzig, Leipzig
| | - H. Gunold
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Leipzig
| | - R. Schubmann
- Abteilung für Kardiologie, Dr. Becker Klinik Möhnesee, Möhnesee
| | - C. Richter
- Fakultät Angewandte Sozialwissenschaften, Hochschule für Technik, Wirtschaft und Kultur Leipzig, Leipzig
| | - G. Grande
- Fakultät Angewandte Sozialwissenschaften, Hochschule für Technik, Wirtschaft und Kultur Leipzig, Leipzig
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