Thomas M Helms

Fachhochschule der Wirtschaft, Paderborn, North Rhine-Westphalia, Germany

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Publications (22)7.14 Total impact

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    ABSTRACT: Dual antiplatelet therapy is the cornerstone of maintenance medication following invasive treatment of patients with acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. The debate was enriched by the results of the large phase III clinical trials for prasugrel (TRITON) and ticagrelor (PLATO) compared to clopidogrel in patients with acute coronary syndromes. This article summarizes the critical details und subanalyses of both study programmes and highlights on clinical decision making when using the three P2Y12 blockers in acute coronary syndromes. A special focus is on higher risk patients such as those with ST elevation myocardial infarction and those with coexisting diabetes, but also on minimizing relevant bleedings, which are common during more intense platelet inhibition.
    DMW - Deutsche Medizinische Wochenschrift 01/2014; 139(4):152-8. · 0.65 Impact Factor
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    ABSTRACT: A health economic analysis was conducted to evaluate the program "Telemedicine for the Heart," which the German Foundation for the Chronically Ill organizes for the Techniker Krankenkasse, one of the biggest German statutory health insurance funds. The program consists of nurse-calls to motivate patients to perform regular self-measurements (blood pressure, pulse, weight) with either their own or telemedical measuring devices provided by the program. In the case of measured values outside of set limits, calls to treating physicians were placed to allow for the initiation of therapy adjustments where applicable. To evaluate the program, a retrospective matched-pairs analysis was performed. Program participants (n=281) and regularly insured patients (n=843) were matched for demographics and morbidity status and compared according to their use of resources. Significant cost differences in favor of the study group of up to 25% in relation to total costs could be detected, particularly in the group of New York Heart Association (NYHA) classification II patients (persons with mild symptoms and slight limitation according to the NYHA classification for the extent of heart failure). In the more severe NYHA stages III and IV the cost relation differed and showed a slight cost disadvantage for the program group. Mortality was 35.1% lower in the program group than in the control group. Quality of life measures were almost constant over the observation time, compatible with a positive impact of the program on the highly impaired patient group. The findings suggest that, besides a reduction of costs, by participating in "Telemedicine for the Heart" patients with chronic heart failure experienced a reduced number of hospital stays, optimized medical therapy, better quality of life, and reduced mortality.
    Telemedicine and e-Health 02/2012; 18(3):198-204. · 1.40 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 03/2011; 136(15):782-5. · 0.65 Impact Factor
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    Modern Pacemakers - Present and Future, 02/2011; , ISBN: 978-953-307-214-2
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    ABSTRACT: Patients with congestive heart failure represent a significant amount of the total annual cost of the health care system. Because of a lack of studies on the economic health cost of the related health care, including all cost generating factors, we analysed in detail characteristics of these patients and the costs created by their care. Data were retrieved from the German Bureau of Health Statistics for the year 2002 relating to congestive heart failure (Code I50) including other factors (e. g. co-morbidities, ambulatory and hospital care and choice of the doctor). The data were from more than 2 million patients, from 350 insurance companies, the Federal Employees Insurance and the German Institute for Medical Informatics and Documentation. A total of 86 193 patients with congestive heart failure had been recorded. More women than men were recorded as having congestive heart failure (66 vs. 34 %). The various health insurance companies paid 2.3 times more for patients with than without congestive heart failure. Nearly three quarters of the cost for these patients (72 %) resulted from in-patient care. Moreover, costs for drugs were three times higher (1073 Euro vs. 366 Euro). This analysis clearly demonstrates the increased costs incurred for patients with congestive heart failure. It should serve as a reference base for better assessing future innovations, such as telemedicine, for their effects in different sectors of health care.
    DMW - Deutsche Medizinische Wochenschrift 04/2010; 135(13):633-8. · 0.65 Impact Factor
  • Deutsche Medizinische Wochenschrift - DEUT MED WOCHENSCHR. 01/2010; 135(13):633-638.
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    ABSTRACT: The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue.
    International Journal of Telemedicine and Applications 01/2010; 2010.
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    ABSTRACT: Recent developments in pacemaker and ICD therapy can be characterized by a rising number of implantations (especially in the field of ICD and CRT systems) and an increasing complexity of the units involved. Problems evolving from this trend are the soaring numbers of necessary follow-up examinations, issues of patient safety and the necessity of device management by specialized physicians. Telemonitoring offers various possibilities of improvement in these areas. The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with pacemakers, ICD and CRT systems. The systems commonly include an implant capable of either automatic or manual data transmission, a device for transmitting the implant's data (mobile communication or fixed line network), a server managing the information and a front-end (internet-based) platform for the physician. Multiple clinical trials have verified the stability and the security of this method of data transmission. Telemedical monitoring can be used in order to improve the monitoring of the patients' state of health (e. g., patients with CRT systems because of their CHF) and the management of arrhythmias (e. g., patients suffering from paroxysmal atrial fibrillation). Telemonitoring allows the intervals between follow-up check-ups to be individualized, thus, leading to financial savings. The telemedical monitoring of patients with ICD and CRT systems facilitates new opportunities for networked follow-up care and comprehensive medical treatment.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 04/2009; 52(3):306-15. · 0.72 Impact Factor
  • A. Müller, J. Schweizer, T.M. Helms
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    ABSTRACT: HintergrundDer demographische Wandel und die immer schwierigere Finanzierungssituation im deutschen Gesundheitssystem haben zu grundlegenden Veränderungen in der Versorgungslandschaft geführt. Am Beispiel der kardiologischen Betreuung werden aktuelle Veränderungen mit ihren Chancen und Problemen dargestellt. MethodenDer Überblick untersucht neben traditionellen, neue Versorgungsstrukturen in der Kardiologie und deren Umsetzung in der klinischen Praxis. ErgebnisseZiel des Disease-Management-Programms (DMP) KHK ist eine Verbesserung der Versorgungsqualität. Erste positive Ergebnisse hinsichtlich der Verbesserung der Morbidität, des Risikofaktorenmanagements und der Adhärenz an eine leitliniengerechte Therapie der KHK liegen vor. Die größte Herausforderung für die Leistungserbringer und Krankenkassen stellt die Einführung der Integrierten Versorgung (IV) dar. Neben Aufhebung der Trennung zwischen ambulanter und stationärer Behandlung ändert sich dabei grundsätzlich die Finanzierung. Die IV ermöglicht die Einführung von Innovationen (z.B. zeitnahe und flächendeckende Koronarintervention bei akutem Koronarsyndrom). SchlussfolgerungNeue Versorgungsstrukturen eröffnen Chancen zur besseren Betreuung von Herzpatienten. Diese neuen Strukturen müssen hinsichtlich der Verbesserung der Versorgungsqualität und der Kosteneffizienz wissenschaftlich evaluiert werden. BackgroundThe demographic shift and the ever more difficult challenge of financing the German healthcare system have led to fundamental changes in all sectors of medical care. By looking in detail at the field of cardiology, current tendencies and developments in medical care will be analysed and their strengths and weaknesses depicted. MethodsThe overview analyses both traditional and new concepts of cardiology and focuses on the points of contact and distinctive methodical features. ResultsThe main ambition of the disease management programme for coronary heath disease is to improve quality of care. By now, encouraging first results concerning the improvement of morbidity, the efficient management of risk factors, and an increased adherence to therapy according to guidelines can be reported. The biggest challenge for health insurance on the one hand and physicians and hospitals on the other is the implementation of concepts of integrated care (in German: Integrierte Versorgung, IV). Not only do these concepts question the separation between ambulant and stationary care, but they also have a general impact on the regulations regarding financing of the healthcare system. Despite these challenges, integrated care does have a positive effect in terms of introducing new, innovative methods and treatment concepts (e.g. the possibility of a fast coronary intervention after acute coronary syndrome, regardless of the patient’s location). ConclusionNew and innovative structures for medical care hold great opportunities for improvements in treating cardiac patients. However, these new structures need scientific analysis so that their effects on quality of care and cost efficiency can be determined.
    Prävention und Gesundheitsförderung 10/2008; 3(4):259-265.
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    ABSTRACT: Telemetric cardiac monitoring was invented in 1949 by Norman J Holter. Its clinical use started in the early 1960s. In the hospital, biotelemetry allows early mobilization of patients with cardiovascular risk and addresses the need for arrhythmia or oxygen saturation monitoring. Nowadays telemetry either uses vendor-specific UHF band broadcasting or the digital ISM band (Industrial, Scientific, and Medical Band) standardized Wi-Fi network technology. Modern telemetry radio transmitters can measure and send multiple physiological parameters like multi-channel ECG, NIPB and oxygen saturation. The continuous measurement of oxygen saturation is mandatory for the remote monitoring of patients with cardiac pacemakers. Real 12-lead ECG systems with diagnostic quality are an advantage for monitoring patients with chest pain syndromes or in drug testing wards. Modern systems are light-weight and deliver a maximum of carrying comfort due to optimized cable design. Important for the system selection is a sophisticated detection algorithm with a maximum reduction of artifacts. Home-monitoring of implantable cardiac devices with telemetric functionalities are becoming popular because it allows remote diagnosis of proper device functionality and also optimization of the device settings. Continuous real-time monitoring at home for patients with chronic disease may be possible in the future using Digital Video Broadcasting Terrestrial (DVB-T) technology in Europe, but is currently not yet available.
    Herzschrittmachertherapie & Elektrophysiologie 10/2008; 19(3):146-54.
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    ABSTRACT: The changes in the demographic structure, the increasing multimorbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of healthcare services with its discontinuous processes and redundancies will lead to intolerable economic burdens in the German health-care system, affecting medical, health-political and economic dimensions alike. This is the significance in terms of content and strategy of "health telematics" as an application of modern telecommunication and information technologies in the health-care system, and of "E-Health" as a specification of all services, quality improvements and rationalization effects, which are achievable by digitizing data collection as well as communication processes. Not only do digitizing and electronic transmission offer a better, faster and safer way of communication, but by possibilities of combining data they also allow the rationalization and quality-improving introduction of new methods of diagnosis, therapy and aftercare. The latest developments and appropriate logistic premises nowadays offer a realistic basis for implementing telemonitoring as a central service and information tool as well as an instrument controlling the information and data flow between patient, hospital and medical practitioner. Considering the enormous significance of cardiovascular diseases, focusing on corresponding cardiologic disease patterns seems almost self-evident. Notwithstanding remarkable medical progress during the past few years, cardiovascular diseases are still the number one cause of death in industrialized countries. In the cardiologic sector, telemedical systems are most commonly used with patients suffering from coronary heart diseases, e.g., for the detection of unclear dysrhythmia, as well as with patients suffering from chronic heart failure. Seen from a medical point of view, it is paramount to judge the clinical situation without delay as well as to take necessary therapeutic measures timely and to control their efficiency over a long period of time.Consequently, telemedical projects include the establishment of a nonstop monitoring of patients with increased or high risk of cardiovascular incidents, starting with the hospitalization, postoperative/post in-house health care and up to home care. This kind of monitoring needs to be adjustable to the respective situation modularly in order to guarantee a smooth possibility of surveillance both in the stationary and the ambulant sector, which, in addition, has to be individually adjustable to the demand of required monitoring functions (heart rate, blood pressure, S-T segments, oxygen satiation, weight, breathing rate, and temperature) and the intensity of the monitoring (event recording, "on-demand" vs. continuous monitoring). Certainly rich in meaning for the future is the integrated telemedicine care of a "primary" cardiac patient with his relevant comorbidities: diabetes and coagulation monitoring, respectively.
    Herz 01/2008; 32(8):641-9. · 0.78 Impact Factor
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    Kardiologie up2date 01/2008; 4(1):3-7.
  • Article: Telemetrie
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    ABSTRACT: Die telemetrische Übertragung des Elektrokardiogramms wurde 1949 von Norman J. Holter erfunden. Bereits Anfang der 1960er Jahre wurde dann in Krankenhäusern die Patiententelemetrie eingesetzt. Die Telemetrie erlaubt eine frühzeitige Mobilisierung von Patienten mit kardiovaskulärem Risiko und der Notwendigkeit einer kontinuierlichen Überwachung. Heutzutage werden für die Telemetrie sowohl Systeme genutzt, die herstellerspezifische UHF-Radiowellentechnologie zur Fernübertragung der physiologischen Parameter verwenden, als auch Systeme, die standardisierte digitale WLAN-Topologien des ISM-Hochfrequenz-Bands einsetzen. Moderne Systeme erlauben nicht nur die Ableitung eines Mehrkanal-EKGs, sondern auch die Übertragung von nicht-invasiven Blutdruckmessungen und der SpO2-Sättigung. Die Messung des SpO2 ist unabdingbar für die Fernüberwachung von Patienten mit Herzschrittmachern. Echte 12-Kanal EKG-Systeme sind für die Überwachung von Patienten in einer „Chest-Pain-Unit“ und bei der Überwachung von Probanden im Rahmen von Medikamenten-Zulassungsstudien von Vorteil. Moderne Systeme bieten dem Patienten durch ihr leichtes Gewicht und optimierte Patientenkabel ein Maximum an Tragekomfort. Entscheidend für die Systemwahl ist die genaue Erkennung von Arrhythmien. Kontinuierliche Echtzeit-Telemetrie-Systeme zur Überwachung chronisch Kranker im häuslichen Umfeld sind bei Nutzung des Potentials von Digital Video Broadcasting Terrestrial (DVB-T) in Zukunft denkbar, derzeit aber noch nicht verfügbar. Zukunftsweisend ist die telemetrische Fernabfrage von Schrittmacherimplantaten. Sie ermöglicht eine Alarmierung bei Fehlfunktionen und eine rasche Geräte-Optimierung. Telemetric cardiac monitoring was invented in 1949 by Norman J Holter. Its clinical use started in the early 1960s. In the hospital, biotelemetry allows early mobilization of patients with cardiovascular risk and addresses the need for arrhythmia or oxygen saturation monitoring. Nowadays telemetry either uses vendor-specific UHF band broadcasting or the digital ISM band (Industrial, Scientific, and Medical Band) standardized Wi-Fi network technology. Modern telemetry radio transmitters can measure and send multiple physiological parameters like multi-channel ECG, NIPB and oxygen saturation. The continuous measurement of oxygen saturation is mandatory for the remote monitoring of patients with cardiac pacemakers. Real 12-lead ECG systems with diagnostic quality are an advantage for monitoring patients with chest pain syndromes or in drug testing wards. Modern systems are light-weight and deliver a maximum of carrying comfort due to optimized cable design. Important for the system selection is a sophisticated detection algorithm with a maximum reduction of artifacts. Home-monitoring of implantable cardiac devices with telemetric functionalities are becoming popular because it allows remote diagnosis of proper device functionality and also optimization of the device settings. Continuous real-time monitoring at home for patients with chronic disease may be possible in the future using Digital Video Broadcasting Terrestrial (DVB-T) technology in Europe, but is currently not yet available.
    Herzschrittmachertherapie & Elektrophysiologie 01/2008; 19(3):146-154.
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    ABSTRACT: Chronic heart failure (CHF) is one of the most common diagnoses in internal medicine. It frequently results in a considerable loss of patient quality of life and is affected by improvable deficits regarding managed care, diagnosis, and treatment. Integrated care conceptions with telemetric support for persons concerned have proven to ameliorate the mentioned deficits. Apart from the resulting medical benefits, another significant advantage of such approaches is a reduction of costs of treatment and care for CHF patients due to a decrease in hospitalizations, which account for the better part of total costs. In this context the non-profit-making German foundation for chronic heart cases ("Deutsche Stiftung für chronisch Herzkranke") has, in cooperation with the statutory health insurance "Techniker Krankenkasse", developed an integrated, telemetric care and education program for patients suffering from CHF. Since January 2006, the conception stands open to all insurants of the participating health insurance. A growing number of patients, momentarily 431, has been inscribed and takes advantage of this program. The 27-month program seeks for integration of all participating health-care providers. Patients are, by frequent nurse-mediated telephone contact under supervision of physicians, intensely and individually cared for. Throughout the program all patients take advantage of repetitive teaching regarding individually relevant aspects of CHF. Subject to the severity of their condition, the patients are, with telemetric support, motivated to implement daily self-measurements of weight, blood pressure and pulse into their everyday life. In the course of every telephone contact greatest care is given to convey knowledge about limit values of measured parameters and symptoms of decompensation on the basis of the acquired data. Participating practicing physicians are regularly informed about the progress of their patients and, if necessary, encouraged to enhance adequate, guideline- and evidence-based pharmacological therapy. By means of interaction of all these program features and subject matters, patients are, beyond the end of the program, empowered to enduringly and self-dependently deal with their chronic disease. Intermediate data suggest that participation of CHF patients in the depicted program is, among other effects, able to decrease hospitalizations, optimize treatment, increase quality of life, and decrease mortality.
    Herz 01/2008; 32(8):623-9. · 0.78 Impact Factor
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    ABSTRACT: Heart failure exhibits a significant clinical and health economic problem. The implementation of new therapeutic strategies favorably affecting the course of disease is still insufficient in day-to-day practice. Thus, the usage of telemedicine offers a central instrument for service and information, so that an optimized therapy can be achieved by consequent surveillance of the patient with chronic heart disease. Predefined vital parameters are automatically transmitted to the telemedicine center; if individually predefined limits are exceeded, therapeutic means are immediately initiated. For the patient, the center is attainable 24 h throughout the year in case he experiences cardio-pulmonary symptoms. This patient-oriented usage of technology should not replace the physician-patient relationship, but improves and supports the participation and self-management of patients. Furthermore, the results show that this technology can significantly reduce the amount of emergency physician services, hospital admissions and primary care physician visits, and displays for health economics purposes a clearly more cost-effective treatment strategy, while allowing for additional costs inherent to the system. The usage of telemonitoring in chronic heart failure patients may be a trendsetting form of care, which can be used to drastically optimize the information and data flow between patient, hospital and primary care physician individually and at any time.
    Herzschrittmachertherapie & Elektrophysiologie 10/2005; 16(3):176-82.
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    ABSTRACT: Die Herzinsuffizienz stellt ein bedeutendes klinisches und gesundheitsökonomisches Problem dar. Die Umsetzung neuer, den Krankheitsverlauf günstig beeinflussender Therapiestrategien und der hieraus resultierenden Therapieleitlinien in der chronischen Herzinsuffizienz sind im Praxisalltag nach wie vor unzureichend. Der Einsatz der Telemedizin bietet sich daher als zentrales Service- und Informationsinstrument an, so dass durch eine konsequente Überwachung des chronisch herzkranken Patienten eine optimierte Therapieführung ermöglicht wird. Vorgegebene Vitalparameter werden automatisch an das telemedizinische Zentrum übermittelt, bei Überschreitung individuell festgelegter Grenzwerte werden umgehend therapeutische Maßnahmen eingeleitet. Bei kardiopulmonalen Symptomen ist das Zentrum an 24 h für 365 Tagen im Jahr für den Patienten erreichbar. Dieser patientenorientierte Technologieeinsatz sollte dabei die Arzt-Patientenbeziehung nicht ersetzen, sondern verbessert und fördert die Partizipation sowie das Selbstmanagement der Patientinnen und Patienten. Außerdem zeigen die Ergebnisse, dass durch diese Technologie die Zahl der Notarzteinsätze, Klinikeinweisungen und Arztbesuche hochsignifikant reduziert werden kann und aus gesundheitsökonomischer Sicht, auch unter Berücksichtigung der systemimmanenten Mehrkosten, die eindeutig kosteneffektivere Behandlungsstrategie darstellt. Der Einsatz der Telemedizin bei chronisch herzinsuffizienten Patienten könnte somit eine zukunftsweisende Betreuungsform darstellen, durch die der Informations- und Datenfluss zwischen Patient, Krankenhaus und niedergelassenem Arzt entscheidend individuell und zu jeder Zeit optimiert werden kann. Heart failure exhibits a significant clinical and health economic problem. The implementation of new therapeutic strategies favorably affecting the course of disease is still insufficient in day-to-day practice. Thus, the usage of telemedicine offers a central instrument for service and information, so that an optimized therapy can be achieved by consequent surveillance of the patient with chronic heart disease. Predefined vital parameters are automatically transmitted to the telemedicine center; if individually predefined limits are exceeded, therapeutic means are immediately initiated. For the patient, the center is attainable 24 h throughout the year in case he experiences cardio-pulmonary symptoms. This patient-oriented usage of technology should not replace the physician-patient relationship, but improves and supports the participation and self-management of patients. Furthermore, the results show that this technology can significantly reduce the amount of emergency physician services, hospital admissions and primary care physician visits, and displays for health economics purposes a clearly more cost-effective treatment strategy, while allowing for additional costs inherent to the system. The usage of telemonitoring in chronic heart failure patients may be a trendsetting form of care, which can be used to drastically optimize the information and data flow between patient, hospital and primary care physician individually and at any time.
    Herzschrittmachertherapie & Elektrophysiologie 08/2005; 16(3):176-182.
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    European Journal of Heart Failure Supplements 06/2005; 4(S1).
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    ABSTRACT: Telemonitoringsysteme stehen heute zur Überwachung von Patienten mit implantierten Herzschrittmachern, Defibrillatoren (ICD) und kardialen Resynchronisationssystemen (CRT) in der klinischen Praxis zur Verfügung. Trotz unterschiedlicher technischer Umsetzungen der Hersteller haben diese Systeme einen einheitlichen Aufbau. Mit Telemonitoring können Daten zum Aggregat-, Arrhythmie- und Herzinsuffizienzmanagement zeitnah übertragen werden. Die Ärzte können über passwortgeschützte Internetplattformen jederzeit sicher auf diese Daten zugreifen. In den letzten Jahren wurden randomisierte klinische Studien zum Telemonitoring bei Patienten mit implantierten Aggregaten abgeschlossen. Durch Telemonitoring sind aggregatbedingte und klinische Ereignisse frühzeitiger erkennbar, die Einleitung entsprechender klinischer Reaktionen zeitnaher möglich. Routinekontrollintervalle können individuell optimiert und Kosten somit reduziert werden. Bei Patienten mit chronischer Herzinsuffizienz kann durch eine telemedizinische Überwachung der CRT- bzw. ICD-Systeme eine drohende kardiale Dekompensation früher erkannt werden. Trotz der positiven Ergebnisse für das Telemonitoring bleiben einzelne Fragen zu Langzeitergebnissen und Kosteneffizienz noch offen. Rechtliche Probleme in der Fernüberwachung sind heute weitestgehend gelöst und die ärztliche Leistung über eine EBM-Ziffer abrechenbar. Trotz dieser Entwicklungen existieren zurzeit noch Barrieren in der Umsetzung telemedizinischer Überwachungskonzepte bei Patienten mit implantierten Aggregaten. Heute sollte schon bei Implantation, insbesondere von CRT- und ICD-Systemen, die Option einer telemedizinischen Überwachung der Patienten in das Gesamtbehandlungskonzept einbezogen werden. Das Ziel muss dabei sein, aus den gewonnenen Informationen zeitnah klinische Aktivitäten abzuleiten. Dafür ist eine entsprechende Logistik und geschultes Personal erforderlich. Aufgrund der aktuellen Studienlage wird insbesondere für Patienten mit ICD-Systemen (Primär- und Sekundärprophylaxe) und CRT-Systemen der Einsatz des Telemonitorings empfohlen.
    Der Kardiologe 7(3).
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    ABSTRACT: Zusammenfassung 5 Hintergrund und Fragestellung: Patienten mit Herzinsuffizienz sind aufgrund ihrer schweren kardialen Erkrankung wesentlich an Kosten des Gesundheitssystems beteiligt. Umfassende Litera-turrecherchen ergaben, dass derzeit noch keine Herzinsuffizienz-Kostenstudie existiert, die die Kosten im stationären Bereich, Kosten für vertrags-ärztliche Leistungen im ambulanten Bereich, Arz-neimittelkosten sowie Kosten für Krankengeld auf-grund von Arbeitsunfähigkeiten reflektiert. Methodik: Datengrundlage für diese Analyse war eine einmalige Erhebung der gesetzlichen Versicherungen im Jahr 2002, an der sich 2 Mio. Versicherte, 350 Krankenkassen, 23 Kassenärztli-che Vereinigungen und ihre Verbände, die Bun-desversicherungsanstalt für Angestellte sowie das Deutsche Institut für medizinische Informa-tion und Dokumentation beteiligten. Dieser Da-tensatz des Statistischen Bundesamtes wurde in Bezug auf die Diagnose I50 (Herzinsuffizienz) unter besonderer Berücksichtigung von Komor-biditäten, Anzahl und Kosten für ambulante und stationäre Behandlungen und die Arztwahl im ambulanten Bereich analysiert. Ergebnisse: Mehr Frauen als Männer wiesen die Diagnose Herzinsuffizienz auf (66% vs. 34%). Herzinsuffiziente Patienten verursachten 2,3-fach höhere Gesamt-Kosten pro Krankenversi-cherten, wobei der Hauptanteil (72%) der Kosten im stationären Bereich anfällt. Insbesondere die durchschnittlichen Arzneimittelkosten pro Pati-ent mit vs. ohne Herzinsuffizienz waren signifi-kant erhöht (1073 vs. 366 Euro). Folgerungen: Die vorliegende Erhebung sollte als Referenzbasis herangezogen werden, um In-novationen, wie sie z. B. telemedizinische Be-treuungsformen darstellen, hinsichtlich ihrer Kosteneffekte sektoral differenziert zu bewerten.
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    ABSTRACT: Die chronische Herzinsuffizienz (CHI) ist eine der häufigsten internistischen Erkrankungen. Sie ist für die Betroffenen in der Regel mit einer erheblichen Einschränkung der Lebensqualität verbunden und mit optimierbaren Defiziten im Versorgungsmanagement sowie in Diagnostik und Therapie behaftet. Integrierte, telemedizinisch gestützte Betreuungskonzepte für CHI-Patienten sind nachweislich geeignete Instrumente, mit denen eine Verbesserung der bestehenden Defizite erreicht wird. Neben dem medizinischen Nutzen ist jedoch auch ein gesundheitsökonomischer Vorteil derartiger Konzeptionen nachweisbar. Dieser resultiert vor allem daraus, dass Krankenhausaufenthalte, die für einen Großteil der Behandlungskosten von CHI-Patienten verantwortlich sind, vermieden werden können. In diesem Kontext hat die gemeinnützige Deutsche Stiftung für chronisch Herzkranke zusammen mit der Techniker Krankenkasse das Integrierte, telemedizinische Patientenbetreuungs- und -schulungsprogramm „Telemedizin fürs Herz“ entwickelt, welches den Versicherten seit dem 01.01.2006 im gesamten Bundesgebiet offensteht und aktuell von 431 Patienten genutzt wird. In dem Programm wird der Patient unter Einbindung aller an seiner Behandlung beteiligten Leistungserbringer über 27 Monate unter ärztlicher Supervision von medizinischen Fachkräften intensiv telefonisch betreut und individuell zu für ihn relevanten Aspekten der CHI geschult. Nachhaltig wird je nach Schweregrad der Erkrankung mit telemetrischer Unterstützung daran gearbeitet, tägliche Selbstmessungen von Gewicht, Blutdruck und Puls in den Alltag des Patienten zu implementieren. Bei allen Patientenkontakten erfolgt die rückgekoppelte Vermittlung von Wissen zu Grenzwerten und Dekompensationszeichen der CHI. In der Kommunikation mit den behandelnden Ärzten wird positiv auf leitliniengerechte, evidenzbasierte Behandlungsstrategien eingewirkt. Im Sinne einer Hilfe zur Selbsthilfe und Selbstbefähigung bekommt der Patient durch das Zusammenwirken der Leistungsinhalte des Programms alles vermittelt, um auch über das Programmende hinaus dauerhaft und eigenverantwortlich mit seiner Erkrankung umzugehen. Die Zwischenergebnisse sprechen dafür, dass durch die Teilnahme von CHI-Patienten an „Telemedizin fürs Herz“ u.a. die Zahl der Krankenhausaufenthalte reduziert, die Therapie optimiert, die Lebensqualität gesteigert und die Mortalität gesenkt werden können. Chronic heart failure (CHF) is one of the most common diagnoses in internal medicine. It frequently results in a considerable loss of patient quality of life and is affected by improvable deficits regarding managed care, diagnosis, and treatment. Integrated care conceptions with telemetric support for persons concerned have proven to ameliorate the mentioned deficits. Apart from the resulting medical benefits, another significant advantage of such approaches is a reduction of costs of treatment and care for CHF patients due to a decrease in hospitalizations, which account for the better part of total costs. In this context the non-profit-making German foundation for chronic heart cases (“Deutsche Stiftung für chronisch Herzkranke”) has, in cooperation with the statutory health insurance “Techniker Krankenkasse”, developed an integrated, telemetric care and education program for patients suffering from CHF. Since January 2006, the conception stands open to all insurants of the participating health insurance. A growing number of patients, momentarily 431, has been inscribed and takes advantage of this program. The 27-month program seeks for integration of all participating health-care providers. Patients are, by frequent nurse-mediated telephone contact under supervision of physicians, intensely and individually cared for. Throughout the program all patients take advantage of repetitive teaching regarding individually relevant aspects of CHF. Subject to the severity of their condition, the patients are, with telemetric support, motivated to implement daily self-measurements of weight, blood pressure and pulse into their everyday life. In the course of every telephone contact greatest care is given to convey knowledge about limit values of measured parameters and symptoms of decompensation on the basis of the acquired data. Participating practicing physicians are regularly informed about the progress of their patients and, if necessary, encouraged to enhance adequate, guideline- and evidence-based pharmacological therapy. By means of interaction of all these program features and subject matters, patients are, beyond the end of the program, empowered to enduringly and self-dependently deal with their chronic disease. Intermediate data suggest that participation of CHF patients in the depicted program is, among other effects, able to decrease hospitalizations, optimize treatment, increase quality of life, and decrease mortality.
    Herz 32(8):623-629. · 0.78 Impact Factor