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Riesenhuber M, Spannbauer A, Gwechenberger M, Pezawas T, Schukro C, Stix G, Goliasch G, Anvari A, Wrba T, Khazen C, Andreas M, Laufer G, Hengstenberg C, Bergler-Klein J, Gyongyosi M. Clinical outcomes of pacemaker implantations before and after cancer diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2873] [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
Background
Cardiotoxicity caused by anticancer treatment affects cardiac conduction. Clinical outcomes of pacemaker patients with newly diagnosed cancer are insufficiently understood.
Purpose
The aim was to investigate the effect of anticancer therapy on pacemaker properties.
Methods
All patients with pacemaker and confirmed cancer diagnosis treated with chemotherapy at our tertiary university hospital were included in this study. The pacemaker database (containing pacemaker related information) was matched with hospital-wide electronic health records (containing cancer types, comorbidities and echo data). Survival data were retrieved from the Statistics Austria Federal Institute. Clinical and pacemaker data of patients with previously diagnosed cancer requiring pacemaker implantation (Group A) were compared to patients with pre-existing pacemaker followed by cancer diagnosis (Group B).
Results
Out of 972 included patients, 295 patients (30.3%) had the pacemaker implantation after their first cancer diagnosis (Group A), and 677 patients (69.7%) had already a pacemaker before their first cancer diagnosis (Group B). Cancer types are displayed in Figure 1. The following cancer types were associated with increased likelihood for pacemaker implantation after cancer diagnosis (Group A): kidney cancer (OR 2.07, 95% CI 1.12 to 3.83, P=0.02), lymphomas (OR 2.27, 95% CI 1.21 to 4.26, P=0.01), and eye cancer (OR 9.29, 95% CI 1.03 to 83.50, P=0.047). Patients in Group A were older at pacemaker implantation (76.0 years [IQR 68.0–82.2] vs. 72.1 years [IQR 64.3–78.0], P<0.001), and single-chamber pacemakers were less frequent (21.8% vs. 32.1%, P=0.001). Pacemaker implantation due to bradycardic atrial fibrillation was less frequent in Group A (15.6% vs. 21.8%, P=0.03), but implantation due to an “unspecified” indication was increased (20.6% vs. 12.7%, P=0.002). Patients in Group A had lower pacing threshold at baseline but had a stronger increase in pacing threshold during the follow-up as indicated in Table 1. No differences regarding left or right ventricular function, left or right end-diastolic diameter, or mitral or tricuspid regurgitation were detected between the groups. Patients in Group A had smaller left atria (59.7±10.7mm vs. 63.9±24.0mm, P=0.02) and smaller right atria (57.9±10.4mm vs. 61.2±11.8mm, P=0.001). Patients with cancer diagnosis requiring pacemaker had worse 10-year survival (31.2% vs. 51.1%, log-rank P<0.001) as shown in Figure 1.
Conclusion
Kidney cancer, lymphoma, and cancer of the eye were associated with increased probability of pacemaker implantation after cancer diagnosis. The significant increase in pacing threshold in patients undergoing chemotherapy could be associated with chemotherapy-induced cardiotoxicity.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 Future and Emerging Technologies Programme Figure 1. Cancer types and survivalTable 1. Baseline characteristics
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Affiliation(s)
- M Riesenhuber
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Spannbauer
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gwechenberger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Pezawas
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - C Schukro
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - G Stix
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Anvari
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Wrba
- Medical University of Vienna, IT Systems & Communications, Vienna, Austria
| | - C Khazen
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - M Andreas
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - G Laufer
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - J Bergler-Klein
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gyongyosi
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
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Riesenhuber M, Spannbauer A, Pezawas T, Schukro C, Gwechenberger M, Stix G, Anvari A, Wrba T, Khazen C, Andreas M, Laufer G, Hengstenberg C, Gyongyosi M. Pacemaker lead-induced progression of primary vs. secondary tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0822] [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
Background
Currently no data are available whether the implantation of right ventricular (RV) pacemaker (PM) lead worsens preexisting primary or secondary (functional due to RV dilatation, RVD) tricuspid regurgitation (TR).
Purpose
The aim of the present retrospective analysis was to assess TR after PM implantation with a RV lead.
Methods
Patients with PM implantation (n=990) were enrolled if they had routine echocardiography including assessment of TR before first implantation and immediately after. RVD and severity of TR were characterized visually. Based on RVD in baseline echocardiography, patients were divided into 2 groups: with primary TR (without preexisting RVD, n=743) or secondary TR (with preexisting RVD, n=243).
Results
Lead-induced worsening of TR was present in both groups (Table 1). Progression from mild/moderate to severe TR was observed in 6.7% of patients with primary TR, compared to 25.6% of patients with secondary TR (P=0.001). Using an ordinal regression model, the probability to progress to severe TR with primary TR was 14.8% (95% CI 11.0%-19.7%), compared to 41.6% (95% CI 40.3%-42.8%) with secondary TR (P<0.001).
Conclusion
Preexisting secondary TR was associated with higher rates of lead-induced progression to severe TR compared to primary TR. Leadless pacing or tricuspid valve clipping post-PM implantation could be an option for patients with preexisting secondary TR and indication for a PM.
Table 1. Patient characteristics.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): This study was supported by the European Union's Horizon 2020 Future and Emerging Technologies Programme [Grant number 732170].
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Affiliation(s)
- M Riesenhuber
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Spannbauer
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Pezawas
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - C Schukro
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gwechenberger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - G Stix
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Anvari
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Wrba
- Medical University of Vienna, IT Systems & Communications, Vienna, Austria
| | - C Khazen
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - M Andreas
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - G Laufer
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gyongyosi
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
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D’Andrea D, Soria F, Gust K, Gontero P, Enikeev D, Taraktin M, Kotov S, Ryabov M, Lusuardi L, Oswald D, Hurle R, Frego N, Wrba T, Shahrokh S. First quarter report from the eBLOC (en-bloc vs conventional resection of primary bladder tumor) trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33379-6] [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: 10/23/2022] Open
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Riesenhuber M, Spannbauer A, Rauscha F, Schmidinger H, Pezawas T, Schukro C, Gwechenberger M, Khazen C, Andreas M, Laufer G, Stix G, Wrba T, Hengstenberg C, Muller C, Gyongyosi M. P6637Survival analysis in pacemaker patients: Independent mortality factors in a single-center large-scale study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6637] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Riesenhuber
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - A Spannbauer
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - F Rauscha
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - H Schmidinger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Pezawas
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - C Schukro
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gwechenberger
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - C Khazen
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - M Andreas
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - G Laufer
- Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
| | - G Stix
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - T Wrba
- Medical University of Vienna, IT Systems & Communications, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - C Muller
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
| | - M Gyongyosi
- Medical University of Vienna, Department of Cardiology, Vienna, Austria
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Abstract
Summary
Objectives:
The exchange of electronic medical data between healthcare providers constitutes an integral part of modern medicine, and its importance is growing. Efficient application on a national level requires a uniform approach to the management of healthcare data exchange, avoiding isolated solutions that are expensive and also incompatible.
Methods:
In this communication we explain the basic concepts of establishing a nationwide framework to guide healthcare data exchange in Austria. To achieve this goal, a three-step approach was adopted: (i) creating general guidelines to direct electronic medical data exchange; (ii) defining detailed standards for electronic messages; (iii) organizing pilot projects to implement these standards, and further improving the general guidelines based on the results of the pilot projects.
Results:
We present the MAGDA-LENA framework which guides healthcare data exchange in Austria, and compare it with the US framework HIPAA. We describe several communication scenarios for which concrete message standards were developed in recent years, based on the MAGDA-LENA framework. We further discuss the implementation of these standards in four pilot projects.
Conclusions:
The strategic approach of managing healthcare data exchange presented in this paper is expected to have a substantial impact on medical informatics in Austria over the next few years.
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Huber P, Kriechbaum K, Scholda C, Duftschmid G, Wrba T, Schmidt-Erfurth U, Mitsch C. eHealth 2015 Special Issue: Impact of Electronic Health Records on the Completeness of Clinical Documentation Generated during Diabetic Retinopathy Consultations. Appl Clin Inform 2017. [DOI: 10.4338/aci-2015-03-ra-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
SummaryBackground: Two years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented.Objectives: To assess the completeness of information documented electronically compared with manually during patient visits.Methods: The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared.Results: In all categories, clinical documentation was more complete in the EHR group.Conclusions: In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness.Citation: Mitsch C, Huber P, Kriechbaum K, Scholda C, Duftschmid G, Wrba T, Schmidt-Erfurth U. Impact of Electronic Health Records on the Completeness of Clinical Documentation Generated during Diabetic Retinopathy Consultations. Appl Clin Inform 2015; 6: 478–487http://dx.doi.org/10.4338/ACI-2015-03-RA-0028
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Mitsch C, Huber P, Kriechbaum K, Scholda C, Duftschmid G, Wrba T, Schmidt-Erfurth U. eHealth 2015 Special Issue: Impact of Electronic Health Records on the Completeness of Clinical Documentation Generated during Diabetic Retinopathy Consultations. Appl Clin Inform 2015; 6:478-87. [PMID: 26448793 DOI: 10.4338/aci-2014-11-ra-0104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 03/31/2015] [Accepted: 05/11/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Two years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented. OBJECTIVES To assess the completeness of information documented electronically compared with manually during patient visits. METHODS The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared. RESULTS In all categories, clinical documentation was more complete in the EHR group. CONCLUSIONS In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness.
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Affiliation(s)
- C Mitsch
- Medical University of Vienna , Department of Ophthalmology and Optometrics, Vienna, Austria
| | - P Huber
- Medical University of Vienna , Department of Ophthalmology and Optometrics, Vienna, Austria
| | - K Kriechbaum
- Medical University of Vienna , Department of Ophthalmology and Optometrics, Vienna, Austria
| | - C Scholda
- Medical University of Vienna , Department of Ophthalmology and Optometrics, Vienna, Austria
| | - G Duftschmid
- Medical University of Vienna , Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - T Wrba
- Medical University of Vienna , Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - U Schmidt-Erfurth
- Medical University of Vienna , Department of Ophthalmology and Optometrics, Vienna, Austria
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Duftschmid G, Wrba T, Gall W, Dorda W. The strategic approach of managing healthcare data exchange in Austria. Methods Inf Med 2004; 43:124-32. [PMID: 15136861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVES The exchange of electronic medical data between healthcare providers constitutes an integral part of modern medicine, and its importance is growing. Efficient application on a national level requires a uniform approach to the management of healthcare data exchange, avoiding isolated solutions that are expensive and also incompatible. METHODS In this communication we explain the basic concepts of establishing a nationwide framework to guide healthcare data exchange in Austria. To achieve this goal, a three-step approach was adopted: (i) creating general guidelines to direct electronic medical data exchange; (ii) defining detailed standards for electronic messages; (iii) organizing pilot projects to implement these standards, and further improving the general guidelines based on the results of the pilot projects. RESULTS We present the MAGDA-LENA framework which guides healthcare data exchange in Austria, and compare it with the US framework HIPAA. We describe several communication scenarios for which concrete message standards were developed in recent years, based on the MAGDA-LENA framework. We further discuss the implementation of these standards in four pilot projects. CONCLUSIONS The strategic approach of managing healthcare data exchange presented in this paper is expected to have a substantial impact on medical informatics in Austria over the next few years.
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Affiliation(s)
- G Duftschmid
- Medical University of Vienna, Department of Medical Computer Sciences, Spitalgasse 23, 1090 Vienna, Austria.
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Dorda W, Wrba T, Duftschmid G, Sachs P, Gall W, Rehnelt C, Boldt G, Premauer W. ArchiMed: a medical information and retrieval system. Methods Inf Med 1999; 38:16-24. [PMID: 10339959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
ArchiMed is a highly flexible medical data storage and retrieval system which adds sophisticated clinical research support to a standard hospital information system (HIS). Currently, the HIS of Vienna General Hospital-University Hospital (2000 beds) stores the clinical data of over 2 million patients. While this system supports patient care (e.g., ADT, clinical chemistry, diagnosis, procedures), it has no features to facilitate research, such as the management of clinical studies. ArchiMed is designed to support clinical research. It includes an independent database, which mirrors virtually all the information held in the HIS while also allowing new data to be collected independently and to be added to the database. Flexible retrieval and analysis of data contained in the database are then possible. Thus, existing patient data can be smoothly incorporated into a study together with data collected specifically for research purposes. The system has already been successfully installed in the departments of surgery and soon in other departments as well.
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Affiliation(s)
- W Dorda
- Department of Medical Computer Sciences, University of Vienna, Austria.
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