Deutsche Stiftung für Chronisch Kranke

IntroductionCardiovascular disease (CVD) represents a public health burden, with high prevalence and significant morbidity and mortality. Although evidence-based interventions exist, there is a need for more individualised care. The European project Individualised care from early risk of cardiovascular disease to established heart failure (iCARE4CVD) aims to personalise CVD prevention and treatment. Participatory health research, which actively involves patients in the planning, implementation and evaluation of projects, plays a crucial role here. However, patient participation is often unsuccessful due to the lack of a representative patient sample who is involved throughout the project’s duration, has knowledge of the project and can contribute their experience.Methods and analysisParticipative Research for Individualised Care in Cardiovascular Diseases is a non-interventional, non-randomised, multicentre mixed-methods study. The aim is to incorporate patients’ insights into several key activities within iCARE4CVD by establishing country-specific patient panels in Belgium, Germany, Ireland and the UK. The primary objective is to identify patients’ preferences, experiences, requirements and needs for better diagnosis, treatment and self-care of CVD. Therefore, 10–12 patients across the CVD spectrum, from early risk to established CVD and heart failure, will be included in each country (40–48 in total). Over 3.5 years, patient panel members are required to complete four tasks: (1) identification of meaningful Patient-Reported Outcome and Experiences Measures, (2) development of a motivational model to increase adherence, (3) feedback on CVD care processes and (4) usability testing of new digital tools developed within iCARE4CVD. These tasks comprise eight activities in the form of paper-based or digital exercises, telephone surveys, written surveys and in-person focus groups. The results will be continuously incorporated into iCARE4CVD.Ethics and disseminationThis study received ethical approval by the Ethics Committee at the Faculty of Medicine of RWTH Aachen University (EK 24-172) and St. Vincent’s University Hospital (RS24-027), Research Ethics Committee. In Geel and Belfast, positive ethics approval is pending. All participants will provide written informed consent prior to enrolment in the study and participation in the first patient panel task. Results will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberDRKS00034899.Protocol versionV2.1, 6 June 2024.

Cardiovascular diseases remain one of the leading causes of death worldwide, placing a significant burden on individuals, families and healthcare systems. Telemedicine, in particular remote monitoring of patients with cardiovascular diseases, reduces this burden as it links the continuous monitoring of the health status with individual education and adaptation of the therapy to the needs of the patients. This improves patient outcomes and facilitates access to specialised healthcare services, independent of time and distance. Furthermore, telemedicine enables improvements in efficiency and promotes patients’ self-care. However, the widespread adoption of remote patient monitoring faces several hurdles. A round table of experts from seven European countries (France, Germany, Italy, Poland, Spain, the Netherlands and the United Kingdom) reviewed the current state of telemedicine within the participating countries in order to learn from each other with an impetus for European co-operation. The creation of reliable regulations, overcoming regional differences, the redefinition of roles and processes, the personalisation of healthcare services, the promotion of innovation and research, the use of artificial intelligence and, finally, the efficient management and safeguarding of healthcare data were identified as key levers for further development of telemedicine. This discussion paper emphasises the need for cross-national research activities, involving all stakeholders, such as researchers, industry and patients, to foster the integration of telemedicine in clinical pathways.

Telemedical care concepts provide opportunities to improve the care of patients with chronic heart failure (CHF). The current state of telemedical technologies enables the effective monitoring of the disease. Germany is one of the first European countries with an entitlement to telemedical supporting care for CHF patients. The decision of the German Federal Joint Committee in 2020 to introduce telemedical supporting care for CHF patients marks amilestone. For the first time, adigital care procedure was included in the benefits catalogue of the statutory health insurance funds due to its proven benefits in terms of morbidity and mortality. Privately insured CHF patients have been entitled to these benefits since January 2024. Future developments, particularly with respect to artificial intelligence procedures in telemedicine, are promising but require more evidence. Further research, technological innovation and supportive policy frameworks are needed to realize the full potential of these approaches. Continued collaboration between healthcare professionals, technology developers and policy makers will be crucial in sustainably improving the care of heart failure patients with telemedicine.

Abstract A common terminology is needed when dealing with information systems. Health information systems, as socio-technical subsystems of a healthcare setting, compriss data, information, and knowledge processes as well as the associated actors. They support information and knowledge logistics.When dealing with health information systems and their architecture, we distinguish between concepts such as entities and entity types, computer-based and non-computer-based application components supporting functions, and physical data processing systems. Electronic health records (EHR) are parts of health information systems that collect patient health data from different health care settings. A patient record is the collection of a patient’s health data from a certain facility.Management of health information systems includes planning, directing, and monitoring tasks. The three-layer graph-based metamodel (3LGM2) is a metamodel that supports the management of health information systems. It describes the components of health information system architectures and their relationships among each other at three layers. It consists of the domain layer to describe functions and entity types, the logical tool layer to describe application components, and the physical tool layer to describe physical tools, as well as the inter-layer relationships between the three layers.

Abstract Management of information systems can be divided into strategic, tactical, and operational management.Strategic management of information systems deals with the information processing of a healthcare facility as a whole. It comprises the planning of the information system’s architecture and of the organization of information management. The tasks of strategic management are planning an information system and its architecture, directing its establishment and its operation, and monitoring its development and operation with respect to the planned objectives. The strategic information management plan represents the long-term planning of the information system of a healthcare facility.Tactical management of information systems deals with particular functions, application components, or physical data processing systems that are introduced, removed, or changed. Usually, these activities are done in the form of projects.Operational management of information systems is responsible for operating the components of the information system. It ensures the smooth operation of the systems in accordance with the strategic information management plan of the healthcare facility.IT governance deals with the organizational structures for decision-making in the management of information systems. Typical organizational structures include the role of a chief information officer who focuses on the strategic management of information systems, an information management board, and a department of information management in charge of the strategic, tactical, and operational management.Management of information systems must find a balance between often conflicting goals, for example, between homogeneity and heterogeneity of the information system architecture or between functional leanness and functional redundancy.

Digital health solutions, applications of artificial intelligence (AI) and new technologies, such as cardiac magnetic resonance imaging and cardiac human genetics are currently being validated in cardiac healthcare pathways. They show promising approaches for improving existing healthcare structures in the future by strengthening the focus on predictive, preventive and personalized medicine. In addition, the accompanying use of digital health applications will become increasingly more important in the future healthcare, especially in patients with chronic diseases. In this article, the authors describe acase of chronic heart failure (HF) as an example to provide an overview of how digitalized healthcare can be efficiently designed across sectors and disciplines in the future. Moreover, the importance of aself-determined patient management for the treatment process itself is underlined. Since HF is frequently accompanied by various comorbidities during the course of the disease that are often recognized only after adelay, the necessity for atimely simultaneous and preventive treatment of multiple comorbidities in cardiovascular diseases is emphasized. Against this background the currently separately applied disease management programs (DMP) are critically questioned. The development of aholistic DMP encompassing all indications for the treatment of chronic diseasesmay pave the way to amore efficient medical care system.

Big data and applications of artificial intelligence (AI), such as machine learning or deep learning, will enrich healthcare in the future and become increasingly important. Among other things, they have the potential to avoid unnecessary examinations as well as diagnostic and therapeutic errors. They could enable improved, early and accelerated decision-making. In the article, the authors provide an overview of current AI-based applications in cardiology. The examples describe innovative solutions for risk assessment, diagnosis and therapy support up to patient self-management. Big data and AI serve as abasis for efficient, predictive, preventive and personalised medicine. However, the examples also show that research is needed to further develop the solutions for the benefit of the patient and the medical profession, to demonstrate the effectiveness and benefits in health care and to establish legal and ethical standards.

One main challenge of health care systems in future will be the care and treatment of dementia patients. To their advanced age, dementia patients do not only have limitations in cognition, perception, and articulation, but also suffer from several other diseases (multimorbidity). These patients have sophisticated needs for assistance, care, and treatment relying on different health care sectors. Well-known communication and coordination deficits between sectors are intensified in the case of dementia, to the above described limitations. Coordination processes concerning the transition of patients from hospitals to inpatient or outpatient aftercare pose particularly difficult. To show a possible future direction for improving intersectoral care of dementia patients, we developed the web-based case management system CASEPLUS-SimPat as part of the project SimPat “Securing Integrated Care for Multi-morbid Patients with Dementia using an IT-based Service Concept”. CASEPLUS-SimPat allows health care professionals, hospital employees and general practitioners, to jointly access patient data and exchange information about the treatment of patients. The case management system was implemented in a three-tier architecture with a role-based authorization concept. A portal for relatives complements the system. By providing precise information and e-learning services, caring relatives are integrated into the care process. In a pilot test, CASEPLUS-SimPat shows a good usability. Adapting aspects, such as keywords used to structure entries will make it easier to find required information, and thus will increase usability. Next steps comprise integration of further health care professionals and care facilities as well as real-life testing in terms of feasibility and effectiveness.

Wird mit herkömmlichen Therapien kein ausreichender Gewichtsverlust erzielt, bietet eine bariatrisch-metabolische Operation effektive Hilfe für schwer adipöse Menschen. Die notwendige lebenslange Nachsorge sichert den Therapieerfolg. Da die Regelversorgung keine sektorenübergreifenden standardisierten und ausreichend finanzierten Lösungen für die Nachsorge bietet, stoßen vorhandene Strukturen in Adipositas-Zentren bereits jetzt an ihre Grenzen.

ZusammenfassungDie Behandlung der chronischen Niereninsuffizienz (chronic kidney disease, CKD) in Klinik und Praxis, auch unter der Dialysetherapie, beinhaltet stets eine umfangreiche medikamentöse Gabe und eine regelmäßige Überwachung. Die Niereninsuffizienz als chronische Erkrankung gehört zu der Gruppe von Krankheiten, die auch von einer nicht medikamentösen Therapie profitiert – nämlich von einer regelmäßigen körperlichen Aktivität. Trotz zahlreicher Publikationen zu diesem Thema werden Bewegung und körperliche Aktivität noch zu wenig bei Patienten mit CKD eingesetzt. Mit den Ergebnissen des Trainings während der Dialyse und dem Rezept für Bewegung gibt es effektive Ansätze, die Faktoren des gesunden Lebensstils in das Behandlungskonzept bei Nierenpatienten einzusetzen.